Learning Curve of Minimally Invasive Surgery Oblique Lumbar Interbody Fusion for Degenerative Lumbar Diseases.

Abstract

To characterize the learning curve for a single surgeon during his initial phases of performing minimally invasive surgery oblique lumbar interbody fusion. This was a prospective analysis of 49 consecutive patients who underwent a single-level minimally invasive surgery oblique lumbar interbody fusion performed by a single surgeon. Patients were divided into group A (first 24 patients) and group B (25 patients after initial 24 patients). The following data were compared between the 2 groups: surgical time, estimated blood loss, radiograph exposure time, clinical and radiographic results, and intraoperative and postoperative complications. The learning curve was assessed using a logarithmic curve-fit regression analysis. Average operative time was significantly longer in group A compared with group B. Compared with group B, group A had significantly more x-ray exposure time. Perioperative complications included thigh numbness and pain in 8 cases, psoas and quadriceps weakness in 3 cases, sympathetic nerve injury in 2 cases, and paralytic ileus in 1 case. All complications were transient and resolved within 3 months. The incidence of complications was 37.5% in group A and 20.0% in group B. Clinical and radiographic outcomes were basically identical in the 2 groups at last follow-up. Minimally invasive surgery oblique lumbar interbody fusion presents a learning curve to the practicing spine surgeon with regard to operative time, x-ray exposure time, and intraoperative and postoperative complications. Close attention to detail can minimize complications that may be associated with the learning curve.