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Learning curve for minimally invasive transforaminal lumbar interbody fusion: a systematic review

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Abstract

Purpose

Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is commonly used to treat degenerative lumbar spinal disorders. It facilitates a full-scale spinal decompression and interbody fusion with minimal neural retraction using the tubular retractor system. Despite the benefits of surgical efficiency and minimalism, this technique requires a long learning curve. There is currently no consensus on the learning curve characteristics and proper training methods for MI-TLIF. Thus, this systematic review aimed to discuss the cutoff point at which technical proficiency is achieved and ways to enhance the learning process.

Methods

Major databases, including PubMed, Embase, and Cochrane Library, were searched for learning curve studies that have evaluated the clinical outcome and learning progress of MI-TLIF using quantitative data. The qualities of the selected studies were assessed using the Newcastle‒Ottawa scale. The plateau points in the “learning curve” were analyzed according to various outcome measures.

Results

Nine full-text articles, representing 753 cases, were included from 9743 screened studies. The most commonly used outcome measures were the operative time, followed by the complication rate. The mean cutoff point for the operative time was 31.33 ± 11.98 (range 13‒45) cases.

Conclusion

The plateau point in the learning curve for MI-TLIF may differ according to the outcome measures used. Most studies have demonstrated the learning progress based on simple task efficiency, rather than patient outcomes. Moreover, the learning rate may be affected by the patients’ and technical conditions. Therefore, great care is required in interpreting the learning curve and cutoff point for MI-TLIF proficiency.

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Acknowledgements

The authors would like to thank Ah Jin Jeon and Eun Young Park for their valuable support and technical assistance.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This study was certified as exempt by the institutional review board (GFIRB2021-422).

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Authors and Affiliations

  1. Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea

    Yong Ahn, Woo-Kyung Kim & Sang-Gu Lee

  2. Department of Health Policy, Korea University, Seoul, Republic of Korea

    Sol Lee

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Ahn, Y., Lee, S., Kim, WK. et al. Learning curve for minimally invasive transforaminal lumbar interbody fusion: a systematic review. Eur Spine J 31, 3551–3559 (2022). https://doi.org/10.1007/s00586-022-07397-3

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