Radiation Exposure in Minimally Invasive Transforaminal Lumbar Interbody Fusion: The Effect of the Learning Curve

Overview

Journal Int J Spine Surg

Date 2019 Feb 27

PMID 30805285

Citations 17

Authors

Abhishek Kumar

Robert K Merrill

Samuel C Overley

Dante M Leven

Joshua J Meaike

Avani Vaishnav

Catherine Gang

Sheeraz A Qureshi

Affiliations

Soon will be listed here.

Abstract

Background: Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has comparable fusion rates and outcomes to the open approach, though many surgeons avoid the technique due to an initial learning curve. No current studies have examined the learning curve of MI-TLIF with respect to fluoroscopy time and exposure. Our objective with this retrospective review was to therefore use a repeatable mathematical model to evaluate the learning curve of MI-TLIF with a focus on fluoroscopy time and exposure.

Methods: We conducted a retrospective review of single level, primary fusions performed by a single surgeon during his initial experience with minimally invasive spine surgery. Chronologic case number was plotted against variables of interest, and learning was identified as the point at which the instantaneous rate of change of a curve fit to the data set equaled the average rate of change of the data set.

Results: One hundred nine cases were reviewed. Proficiency in operative time was achieved at 38 cases with the first 38 requiring a median of 137 minutes compared to 104 minutes for the latter 71 cases ( < .0001). Mastery of fluoroscopy use occurred at case 51. The median fluoroscopy time for the first 51 cases was 2.8 minutes, which dropped to 2.1 minutes for cases 52 to 109 ( < .0001). The complication rate plateaued after 43 cases, with 3 of 11 total complications occurring in the latter 76 cases.

Conclusions: Our results demonstrate the most gradual learning occurred with respect to fluoroscopy time and exposure, and operative time improved the quickest.

Level Of Evidence: IV.

Clinical Relevance: These findings may guide spine surgeon education and training in minimally invasive techniques, and help determine safe case loads for radiation exposure during the initial learning phase of the technique. The model used to identify the learning curve can also be applied to several fields and surgical techniques.

Citing Articles

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Challenges in Contemporary Spine Surgery: A Comprehensive Review of Surgical, Technological, and Patient-Specific Issues.

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Does indirect decompression by oblique lateral interbody fusion produce similar clinical and radiological outcomes to direct decompression by open transforaminal lumbar interbody fusion.

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Merc M, Fokter S, Sha I I BMC Musculoskelet Disord. 2023; 24(1):575.

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Urakawa H, Sato K, Vaishnav A, Lee R, Chaudhary C, Mok J Eur Spine J. 2023; 32(7):2326-2335.

PMID: 37010611 DOI: 10.1007/s00586-023-07533-7.

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