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LEARNING CURVE IN SINGLE-LEVEL MINIMALLY INVASIVE TLIF: EXPERIENCE OF A NEUROSURGEON

CURVA DE APRENDIZAGEM EM TLIF MINIMAMENTE INVASIVA EM UM NÍVEL: EXPERIÊNCIA DE UM NEUROCIRURGIÃO

CURVA DE APRENDIZAJE EN TLIF POR MÍNIMA INVASIÓN DE UN NIVEL: EXPERIENCIA DE UN NEUROCIRUJANO

ABSTRACT

Objective: To describe the learning curve that shows the progress of a single neurosurgeon when performing single-level MI-TLIF. Methods: We included 99 consecutive patients who underwent single-level MI-TLIF by the same neurosurgeon (JASS). Patient’s demographic characteristics were analyzed. In addition, surgical time, intraoperative blood loss and hospital stay were evaluated. The learning curves were calculated with a piecewise regression model. Results: The mean age was 54.6 years. The learning curves showed an inverse relationship between the surgical experience and the variable analyzed, reaching an inflection point for surgical time in case 43 and for blood loss in case 48. The mean surgical time was 203.3 minutes (interquartile range [IQR] 150-240 minutes), intraoperative bleeding was 97.4ml (IQR 40-100ml) and hospital stay of four days (IQR 3-5 days). Conclusions: MI-TLIF is a very frequent surgical procedure due to its effectiveness and safety, which has shown similar results to open procedure. According to this study, the required learning curve is slightly higher than for open procedures, and is reached after about 45 cases.

Keywords:
Learning curve; Lumbar vertebrae; Spinal fusion; Minimally invasive surgical procedures; Intervertebral disc degeneration; Treatment outcome

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