Learning curve analysis of unilateral biportal endoscopic lumbar interbody fusion_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Ning ¹ , BEI Chaoyong ² , WAN Jian ¹ ,  WANG Honggang ¹

1. Department of Spine Surgery, Affiliated Hospital of Guilin Medical College, Guilin Guangxi, 541000, P. R. China;
2. Department of Trauma Surgery, Affiliated Hospital of Guilin Medical College, Guilin Guangxi, 541000, P. R. China;

Corresponding author：

WANG Honggang, Email: whg_81@163.com

Keywords：

Unilateral biportal endoscopy technique; posterior lumbar decompression and fusion; learning curve

DOI：

10.7507/1002-1892.202205139

Video：

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Objective To analyze the learning curve of unilateral biportal endoscopic lumbar interbody fusion (UBE-LIF). Methods Fifty-five patients with single-segment lumbar degenerative disease treated with UBE-LIF between December 2020 and February 2022 were selected as the research subjects. The patients were grouped according to the operation sequence, the first 27 cases were in the early group, and the last 28 cases were in the late group. There was no significant difference between the two groups in age, gender, disease type, and surgical segment distribution (P>0.05). The operation time, the amount of hemoglobin loss (the difference between 1 day before operation and 3 days after operation), the hospital stay after operation, and the incidence of perioperative complications were recorded; the learning curve of UBE-LIF was analyzed by log-curve regression analysis. Results All the operations were successfully completed without changing to other operations. The operation time, the amount of hemoglobin loss, and hospital stay in the early group were significantly more than those in the late group (P<0.05). Complications occurred in 2 cases (7.4%) in the early group, including 1 case of dural tear during operation and 1 case of epidural hematoma after operation, and 1 case (3.6%) with transient radiculitis in the late group. There was no significant difference in the incidence of complications between the two groups (P=0.518) . The log-curve regression analysis showed that the operation time decreased significantly with the increase of the number of patients (P<0.05). The operation time tended to be stable after the surgeon completed 17 cases. Conclusion For single-level lumbar degenerative disease, the operation time of UBE-LIF can decrease gradually with the increase of the number of patients, and tend to be stable after 17 cases.

Citation： WANG Ning, BEI Chaoyong, WAN Jian, WANG Honggang. Learning curve analysis of unilateral biportal endoscopic lumbar interbody fusion. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(10): 1229-1233. doi: 10.7507/1002-1892.202205139 Copy

1.	Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N Engl J Med, 2008, 358(8): 818-825.
2.	Phillips FM, Slosar PJ, Youssef JA, et al. Lumbar spine fusion for chronic low back pain due to degenerative disc disease: a systematic review. Spine (Phila Pa 1976), 2013, 38(7): E409-E422.
3.	姜乐涛, 杜建伟. 腰椎管狭窄症的治疗进展. 局解手术学杂志, 2021, 30(11): 1012-1017.
4.	Hari A, Krishna M, Rajagandhi S, et al. Minimally invasive transforaminal lumbar interbody fusion-indications and clinical experience. Neurol India, 2016, 64(3): 444-454.
5.	钟睿, 王润生, 刘建恒, 等. 不同入路微创经椎间孔腰椎间融合术治疗单节段腰椎管狭窄症的疗效比较. 中国修复重建外科杂志, 2019, 33(7): 807-813.
6.	Kim JE, Yoo HS, Choi DJ, et al. Comparison of minimal invasive versus biportal endoscopic transforaminal lumbar interbody fusion for single-level lumbar disease. Clin Spine Surg, 2021, 34(2): E64-E71.
7.	汪文龙, 刘正, 吴四军, 等. 单侧双通道内镜下减压治疗腰椎管狭窄症的早期疗效观察. 中国脊柱脊髓杂志, 2021, 31(10): 911-918.
8.	田大胜, 刘建军, 朱斌, 等. 单边双通道内镜技术治疗腰椎间盘突出症和腰椎椎管狭窄症. 中华骨科杂志, 2020, 40(17): 1155-1164.
9.	张伟, 党晨珀, 姚彦斌, 等. 单侧双通道脊柱内镜治疗腰椎间盘突出症的临床疗效. 西北国防医学杂志, 2021, 42(5): 341-346.
10.	Heo DH, Hong YH, Lee DC, et al. Technique of biportal endoscopic transforaminal lumbar interbody fusion. Neurospine, 2020, 17(Suppl 1): S129-S137.
11.	朱斌, 田大胜, 陈磊, 等. 单边双通道内镜技术在腰椎疾病中的应用研究进展. 中华骨科杂志, 2020, 40(15): 1030-1038.
12.	Heo DH, Son SK, Eum JH, et al. Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results. Neurosurg Focus, 2017, 43(2): E8. doi: 10.3171/2017.5.FOCUS17146.
13.	李佳奇, 王林峰, 高显达, 等. MIS-TLIF治疗腰椎退变性疾病的研究进展. 中国矫形外科杂志, 2018, 26(7): 631-634.
14.	Park SM, Kim GU, Kim HJ, et al. Is the use of a unilateral biportal endoscopic approach associated with rapid recovery after lumbar decompressive laminectomy? A preliminary analysis of a prospective randomized controlled trial. World Neurosurg, 2019, 128: e709-e718.
15.	Jubbal KT, Chang D, Izaddoost SA, et al. Resident involvement in microsurgery: An American college of surgeons national surgical quality improvement program analysis. J Surg Educ, 2017, 74(6): 1124-1132.
16.	郑超, 刘俊朋, 马炜, 等. 三角技术在脊柱单侧双通道内镜手术中的应用: 38例临床病例比较研究. 空军医学杂志, 2021, 37(5): 413-417.
17.	王彬, 武振方. 单侧双通道脊柱内镜技术并发症及处理的研究进展. 医学研究生学报, 2021, 34(7): 756-760.
18.	Park MK, Park SA, Son SK, et al. Correction to: Clinical and radiological outcomes of unilateral biportal endoscopic lumbar interbody fusion (ULIF) compared with conventional posterior lumbar interbody fusion (PLIF): 1-year follow-up. Neurosurg Rev, 2019, 42(3): 763. doi: 10.1007/s10143-019-01131-2.
19.	Zhang H. Letter to the Editor concerning “A less invasive surgical approach in the lumbar lateral recess stenosis: direct approach to the medial wall of the pedicle” by A Colak et al. (2008) Eur Spine J; 17: 1745-1751. Eur Spine J, 2015, 24(6): 1324-1325.

1. Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N Engl J Med, 2008, 358(8): 818-825.
2. Phillips FM, Slosar PJ, Youssef JA, et al. Lumbar spine fusion for chronic low back pain due to degenerative disc disease: a systematic review. Spine (Phila Pa 1976), 2013, 38(7): E409-E422.
3. 姜乐涛, 杜建伟. 腰椎管狭窄症的治疗进展. 局解手术学杂志, 2021, 30(11): 1012-1017.
4. Hari A, Krishna M, Rajagandhi S, et al. Minimally invasive transforaminal lumbar interbody fusion-indications and clinical experience. Neurol India, 2016, 64(3): 444-454.
5. 钟睿, 王润生, 刘建恒, 等. 不同入路微创经椎间孔腰椎间融合术治疗单节段腰椎管狭窄症的疗效比较. 中国修复重建外科杂志, 2019, 33(7): 807-813.
6. Kim JE, Yoo HS, Choi DJ, et al. Comparison of minimal invasive versus biportal endoscopic transforaminal lumbar interbody fusion for single-level lumbar disease. Clin Spine Surg, 2021, 34(2): E64-E71.
7. 汪文龙, 刘正, 吴四军, 等. 单侧双通道内镜下减压治疗腰椎管狭窄症的早期疗效观察. 中国脊柱脊髓杂志, 2021, 31(10): 911-918.
8. 田大胜, 刘建军, 朱斌, 等. 单边双通道内镜技术治疗腰椎间盘突出症和腰椎椎管狭窄症. 中华骨科杂志, 2020, 40(17): 1155-1164.
9. 张伟, 党晨珀, 姚彦斌, 等. 单侧双通道脊柱内镜治疗腰椎间盘突出症的临床疗效. 西北国防医学杂志, 2021, 42(5): 341-346.
10. Heo DH, Hong YH, Lee DC, et al. Technique of biportal endoscopic transforaminal lumbar interbody fusion. Neurospine, 2020, 17(Suppl 1): S129-S137.
11. 朱斌, 田大胜, 陈磊, 等. 单边双通道内镜技术在腰椎疾病中的应用研究进展. 中华骨科杂志, 2020, 40(15): 1030-1038.
12. Heo DH, Son SK, Eum JH, et al. Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results. Neurosurg Focus, 2017, 43(2): E8. doi: 10.3171/2017.5.FOCUS17146.
13. 李佳奇, 王林峰, 高显达, 等. MIS-TLIF治疗腰椎退变性疾病的研究进展. 中国矫形外科杂志, 2018, 26(7): 631-634.
14. Park SM, Kim GU, Kim HJ, et al. Is the use of a unilateral biportal endoscopic approach associated with rapid recovery after lumbar decompressive laminectomy? A preliminary analysis of a prospective randomized controlled trial. World Neurosurg, 2019, 128: e709-e718.
15. Jubbal KT, Chang D, Izaddoost SA, et al. Resident involvement in microsurgery: An American college of surgeons national surgical quality improvement program analysis. J Surg Educ, 2017, 74(6): 1124-1132.
16. 郑超, 刘俊朋, 马炜, 等. 三角技术在脊柱单侧双通道内镜手术中的应用: 38例临床病例比较研究. 空军医学杂志, 2021, 37(5): 413-417.
17. 王彬, 武振方. 单侧双通道脊柱内镜技术并发症及处理的研究进展. 医学研究生学报, 2021, 34(7): 756-760.
18. Park MK, Park SA, Son SK, et al. Correction to: Clinical and radiological outcomes of unilateral biportal endoscopic lumbar interbody fusion (ULIF) compared with conventional posterior lumbar interbody fusion (PLIF): 1-year follow-up. Neurosurg Rev, 2019, 42(3): 763. doi: 10.1007/s10143-019-01131-2.
19. Zhang H. Letter to the Editor concerning “A less invasive surgical approach in the lumbar lateral recess stenosis: direct approach to the medial wall of the pedicle” by A Colak et al. (2008) Eur Spine J; 17: 1745-1751. Eur Spine J, 2015, 24(6): 1324-1325.

Chinese Journal of Reparative and Reconstructive Surgery

Learning curve analysis of unilateral biportal endoscopic lumbar interbody fusion

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