Skip to main content
SpringerLink
Log in

Learning curve and clinical outcomes of percutaneous endoscopic transforaminal decompression for lumbar spinal stenosis

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

To define and analyze the learning curve of percutaneous endoscopic transforaminal decompression (PETD) for lumbar spinal stenosis (LSS).

Methods

From July 2015 to September 2016, 78 patients underwent PETD; one of whom was converted to open surgery, two were lost, and 75 were included in this study. Clinical results were assessed by using the Oswestry Disability Index (ODI) and visual analog scale (VAS). The learning curve was assessed by a logarithmic curve-fitting regression analysis. Of these 75 patients, 35 were defined as the “early” group, and 40 were defined as the “late” group for comparison.

Results

The mean follow-up was 25.37 ± 4.71 months. The median operative time gradually decreased from 95 (interquartile range, IQR, 85–110) minutes for the early group to 70 (IQR, 60–80) minutes for the late group (P < .000), and an asymptote was reached after approximately 35 cases. After surgery, the VAS for leg pain (LP) and ODI decreased significantly and remained constant during the follow-up. However, the VAS of low back pain (LBP) increased mildly. The total complication rate was 6.6%. ODI, VAS of LP and of LBP, and complication rate did not significantly differ between two groups. Early ambulation and short hospital stay after surgery were achieved.

Conclusion

The learning curve of PETD for LSS was assessed and good clinical results were achieved. The surgeon’s experience with this technique correlated with reduced operation time. Proper patient selection, familiarity with pathological anatomy, and manipulation under endoscopic view may shorten the learning curve and decrease complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Katz JN, Harris MB (2008) Clinical practice. Lumbar spinal stenosis. N Engl J Med 358:818–825. https://doi.org/10.1056/NEJMcp0708097

    Article  CAS  PubMed  Google Scholar 

  2. Phillips FM, Slosar PJ, Youssef JA et al (2013) Lumbar spine fusion for chronic low back pain due to degenerative disc disease: a systematic review. Spine 38:E409–E422. https://doi.org/10.1097/BRS.0b013e3182877f11

    Article  PubMed  Google Scholar 

  3. Deyo RA, Mirza SK, Martin BI et al (2010) Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 303:1259–1265. https://doi.org/10.1001/jama.2010.338

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Du Bois M, Szpalski M, Donceel P (2012) A decade’s experience in lumbar spine surgery in Belgium: sickness fund beneficiaries, 2000–2009. Eur Spine J 21:2693–2703. https://doi.org/10.1007/s00586-012-2381-1

    Article  PubMed  PubMed Central  Google Scholar 

  5. Foley KT, Holly LT, Schwender JD (2003) Minimally invasive lumbar fusion. Spine 28:S26–S35

    PubMed  Google Scholar 

  6. Ozgur BM, Aryan HE, Pimenta Let al (2006) Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 6:435–443

  7. Mayer HM (1997) A new microsurgical technique for minimally invasive anterior lumbar interbody fusion. Spine 22:691–699 discussion 700

    Article  CAS  PubMed  Google Scholar 

  8. Silvestre C, Mac-Thiong JM, Hilmi R et al (2012) Complications and morbidities of mini-open anterior retroperitoneal lumbar Interbody fusion: oblique lumbar interbody fusion in 179 patients. Asian Spine J 6:89–97. https://doi.org/10.4184/asj.2012.6.2.89

    Article  PubMed  PubMed Central  Google Scholar 

  9. Seng C, Siddiqui MA, Wong KP et al (2013) Five-year outcomes of minimally invasive versus open transforaminal lumbar interbody fusion: a matched-pair comparison study. Spine 38:2049–2055. https://doi.org/10.1097/BRS.0b013e3182a8212d

    Article  PubMed  Google Scholar 

  10. Deyo RA, Ciol MA, Cherkin DC et al (1993) Lumbar spinal fusion-a cohort study of complications, reoperations, and resource use in the Medicare population. Spine 18:1463–1470

    Article  CAS  PubMed  Google Scholar 

  11. Khan NR, Clark AJ, Lee SL et al (2015) Surgical outcomes for minimally invasive vs open transforaminal lumbar interbody fusion: an updated systematic review and meta-analysis. Neurosurgery 77:847–874. https://doi.org/10.1227/NEU.0000000000000913

    Article  PubMed  Google Scholar 

  12. Goldstein CL, Phillips FM, Rampersaud YR (2016) Comparative effectiveness and economic evaluations of open versus minimally invasive posterior or transforaminal lumbar interbody fusion: a systematic review. Spine 41:S74–S89. https://doi.org/10.1097/BRS.0000000000001462

    Article  PubMed  Google Scholar 

  13. Xu BS, Tan QS, Xia Q et al (2010) Bilateral decompression via unilateral fenestration using mobile microendoscopic discectomy technique for lumbar spinal stenosis. Orthop Surg 2:106–110. https://doi.org/10.1111/j.1757-7861.2010.00072.x

    Article  PubMed  PubMed Central  Google Scholar 

  14. Perez-Cruet MJ, Foley KT, Isaacs RE et al (2002) Microendoscopic lumbar discectomy: technical note. Neurosurgery 51:S129–S136

    PubMed  Google Scholar 

  15. Kim HS, Paudel B, Jang JS et al (2017) Percutaneous full endoscopic bilateral lumbar decompression of spinal stenosis through uniportal-contralateral approach: techniques and preliminary results. World Neurosurg 103:201–209. https://doi.org/10.1016/j.wneu.2017.03.130

    Article  PubMed  Google Scholar 

  16. Xiong C, Li T, Kang H et al (2019) Early outcomes of 270-degree spinal canal decompression by using TESSYS-ISEE technique in patients with lumbar spinal stenosis combined with disk herniation. Eur Spine J 28:78–86. https://doi.org/10.1007/s00586-018-5655-4

    Article  PubMed  Google Scholar 

  17. Shin SH, Bae JS, Lee SH et al (2018) Transforaminal endoscopic decompression for lumbar spinal stenosis: a novel surgical technique and clinical outcomes. World Neurosurg 114:e873–ee82. https://doi.org/10.1016/j.wneu.2018.03.107

    Article  PubMed  Google Scholar 

  18. Ahn Y (2014) Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices 11:605–616. https://doi.org/10.1586/17434440.2014.940314

    Article  CAS  PubMed  Google Scholar 

  19. Wang Y, Dou Q, Yang J et al (2018) Percutaneous endoscopic lumbar decompression for lumbar lateral spinal canal stenosis: classification of lateral region of lumbar spinal canal and surgical approaches. World Neurosurg 119:e276–e283. https://doi.org/10.1016/j.wneu.2018.07.133

    Article  PubMed  Google Scholar 

  20. Schizas C, Theumann N, Burn A et al (2010) Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine 35:1919–1924. https://doi.org/10.1097/BRS.0b013e3181d359bd

    Article  PubMed  Google Scholar 

  21. Benzel EC, Orr RD (2011) A steep learning curve is a good thing! Spine J 11:131–132. https://doi.org/10.1016/j.spinee.2010.12.012

    Article  PubMed  Google Scholar 

  22. Nowitzke AM (2005) Assessment of the learning curve for lumbar microendoscopic discectomy. Neurosurgery 56:755–762

    Article  PubMed  Google Scholar 

  23. Ramsay CR, Grant AM, Wallace SA et al (2000) Assessment of the learning curve in health technologies. A systematic review. Int J Technol Assess Health Care 16:1095–1108

    Article  CAS  PubMed  Google Scholar 

  24. Lee JC, Jang HD, Shin BJ (2012) Learning curve and clinical outcomes of minimally invasive transforaminal lumbar interbody fusion: our experience in 86 consecutive cases. Spine 37:1548–1557. https://doi.org/10.1097/BRS.0b013e318252d44b

    Article  PubMed  Google Scholar 

  25. Hua W, Zhang Y, Wu X et al (2019) Full-endoscopic visualized foraminoplasty and discectomy under general anesthesia in the treatment of L4-L5 and L5-S1 disc herniation. Spine 44:E984–E991. https://doi.org/10.1097/BRS.0000000000003014

    Article  PubMed  Google Scholar 

  26. Anderson DG, Tannoury C (2005) Molecular pathogenic factors in symptomatic disc degeneration. Spine J 5:260S–266S

    Article  PubMed  Google Scholar 

  27. Zhang YG, Guo TM, Guo X et al (2009) Clinical diagnosis for discogenic low back pain. Int J Biol Sci 5:647–658

    Article  PubMed  PubMed Central  Google Scholar 

  28. Haher TR, O’Brien M, Dryer JW et al (1994) The role of the lumbar facet joints in spinal stability. Identification of alternative paths of loading. Spine 19:2667–2670 discussion 2671

    Article  CAS  PubMed  Google Scholar 

  29. Yeung AT, Tsou PM (2002) Posterolateral endoscopic excision for lumbar disc herniation-surgical technique, outcome, and complications in 307 consecutive cases. Spine 27:722–731

    Article  PubMed  Google Scholar 

  30. Ruetten S, Komp M, Merk H et al (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine 33:931–939. https://doi.org/10.1097/BRS.0b013e31816c8af7

    Article  PubMed  Google Scholar 

  31. Wang B, Lu G, Patel AA et al (2011) An evaluation of the learning curve for a complex surgical technique: the full endoscopic interlaminar approach for lumbar disc herniations. Spine J 11:122–130. https://doi.org/10.1016/j.spinee.2010.12.006

    Article  PubMed  Google Scholar 

  32. Nellensteijn J, Ostelo R, Bartels R et al (2010) Transforaminal endoscopic surgery for lumbar stenosis: a systematic review. Eur Spine J 19:879–886. https://doi.org/10.1007/s00586-009-1272-6

    Article  PubMed  PubMed Central  Google Scholar 

  33. Ruetten S, Komp M, Merk H et al (2007) Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine 6:521–530

    Article  PubMed  Google Scholar 

  34. Choi G, Lee SH, Raiturker PP et al (2006) Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope. Neurosurgery 58:59–68

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedics Surgery, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China

    Jin Yang, Chuan Guo, Qingquan Kong, Bin Zhang, Yu Wang, Lifeng Zhang, Hao Wu, Zhiyu Peng, Yuqing Yan & Dongfeng Zhang

  2. Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000, Sichuan, China

    Jin Yang

Authors
  1. Jin Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chuan Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qingquan Kong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lifeng Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hao Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zhiyu Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yuqing Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Dongfeng Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Qingquan Kong.

Ethics declarations

The device(s) is/are FDA approved or approved by corresponding national agency for this indication. This retrospective study was approved by the West China Hospital Ethics Committee.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Jin Yang and Chuan Guo are co-first authors

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, J., Guo, C., Kong, Q. et al. Learning curve and clinical outcomes of percutaneous endoscopic transforaminal decompression for lumbar spinal stenosis. International Orthopaedics (SICOT) 44, 309–317 (2020). https://doi.org/10.1007/s00264-019-04448-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-019-04448-1

Keywords

Search

Navigation