Learning curves for minimally invasive spine surgeries: Are they worth it?

Abstract

Background: Minimally invasive surgery (MIS) spine procedures were developed to limit operative time, the extent of dissection, and reduce perioperative morbidity. Here, we asked what are the "learning curves" for these MIS spine procedures?

Methods: We reviewed studies in the literature that discussed the "learning curves" attributed to performing different MIS spine surgical procedures. Of interest, the majority were single-surgeon series.

Results: Very few articles assessed the learning curves for different MIS spine procedures. One study reported no learning curve for open vs. MIS discectomy/laminotomy. Another study indicated that 20-30 cases were required for a surgeon to become proficient in performing a variety of MIS spine fusions [e.g., cervical MIS fusions, MIS anterior lumbar interbody fusions (ALIF), MIS transforaminal lumbar interbody fusions (TLIF), and MIS pedicle/screw placement in the thoracic/lumbar spine]. Several other studies specifically cited that, to become proficient in the performance of TLIF, surgeons had to have performed between 10, to 32, to 40, to 44 such cases.

Conclusions: There is a very limited literature available that focuses on the "learning curves" associated with the performance of different types of MIS spine procedures. The number of cases required to satisfy the "learning curves" for different operations varied from 0 for MIS vs. open discectomy/laminotomy, to 20-30 for a variety of cervical-thoracic-lumbar procedures, and up to 44 cases for TLIF. Shouldn't we ask whether better oversight measures and/or mentoring programs could limit the morbidity/AE occurring during these "learning curves" in the future?

Keywords: Adverse events; learning curve; minimally invasive spine surgery; minimizing; morbidity; mortality; under-reporting.