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Navigation improves the learning curve of transforamimal percutaneous endoscopic lumbar discectomy

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Abstract

Purpose

Beginners usually need increased punctures and dozens of fluoroscopy in learning transforamimal percutaneous endoscopic lumbar discectomy (tPELD). Navigator-assisted spinal surgery (NASS) is a novel technique that could induce a definite trajectory. The retrospective study aimed to investigate the impact of a definite trajectory on the learning curve of tPELD.

Methods

A total of 120 patients with symptomatic lumbar disc herniation who received tPELD between 2012 and 2014. Patients receiving tPELD with NASS technique by one surgeon were regarded as group A, and those receiving conventional methods by another surgeon were regarded as group B. Each group was divided into three subgroups (case 1–20, case 21–40, case 41–60).

Results

The fluoroscopy times were 22.62 ± 3.80 in group A and 34.32 ± 4.78 in group B (P < 0.001). The pre-operative location time was 3.56 ± 0.60 minutes in group A and 5.49 ± 1.48 minutes in group B (P < 0.001). The puncture-channel time was 21.85 ± 4.31 minutes in group A and 34.20 ± 8.88 minutes in group B (P < 0.001). The operation time was 84.62 ± 9.20 minutes in group A and 101.97 ± 14.92 minutes in group B (P < 0.001), and the learning curve of tPELD in group A was steeper than that in group B. No significant differences were detected in patient-reported outcomes, hospital stay, patient satisfaction, and complication rate between the two groups (p > 0.05).

Conclusions

Definite trajectory significantly reduced the operation time, preoperative location time, puncture-channel time, and fluoroscopy times of tPELD by beginners, and thus reshaped the learning curve of tPELD and minimized the radiation exposure.

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Acknowledgments

We thanks the nurses who help us collect the clinical data, and further-education physicians who recorded the sequential fluoroscopy films. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Authors and Affiliations

  1. Orthopedic Department, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China

    Guoxin Fan, Ruoshuang Han, Xin Gu, Hailong Zhang, Xiaofei Guan, Yunshan Fan, Teng Wang & Shisheng He

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  1. Guoxin Fan
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Correspondence to Shisheng He.

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Fan, G., Han, R., Gu, X. et al. Navigation improves the learning curve of transforamimal percutaneous endoscopic lumbar discectomy. International Orthopaedics (SICOT) 41, 323–332 (2017). https://doi.org/10.1007/s00264-016-3281-5

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