Analysis of Learning Curve for Minimally Invasive Transforaminal Lumbar Interbody Fusion Byung-Joon Shin, Jae Chul Lee , Hae-Dong Chang, Su-Jin Yun, Yon-Il Kim Spine Center Department of Orthopaedic Surgery Soonchunhyang University Hospital Seoul, Korea
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Analysis of Learning Curve for Minimally Invasive Transforaminal
Lumbar Interbody Fusion
Byung-Joon Shin, Jae Chul Lee, Hae-Dong Chang,
Su-Jin Yun, Yon-Il Kim
Spine Center
Department of Orthopaedic Surgery
Soonchunhyang University Hospital
Seoul, Korea
Learning curve for MIS TLIF
SCH spine center
Oct 15, 2009
¬ Minimally Invasive TLIF• Advantages
– Decreased soft tissue injury
• Unilateral exposure & less muscle dissection
• Preservation of contralateral structure
– Decreased operative bleeding
• Disadvantages– Technically demanding
– Increased operative time
Introduction
Steep learning curve
Peng et al., Spine, 2009; Scheufler et al., Neurosurg, 2007; Schizas, Int Orthop, 2008
Learning curve for MIS TLIF
SCH spine center
Oct 15, 2009
¬ ‘New’ vs. ‘Gold standard’ procedure
A. False negative result– Too early assessment
B. Indifferent result
C. Positive result
Introduction
New
Old(Gold standard)
Ramsay CR et al: Statistical assessment of the learning curves of health technologies.
Health Technol Assess 5:1–79, 2001
Learning curve
for MIS TLIF?
When?
Learning curve for MIS TLIF
SCH spine center
Oct 15, 2009
¬ Prospective analysis of • The first 41 cases of MIS TLIF
procedure• Degenerative lumbar disease treated
by– Decompression thru tubular retractor
– Obliquely inserted a PEEK cage
– Percutaneous pedicle screw fixation and fusion
• F/U > minimum 1yr
Materials
Learning curve for MIS TLIF
SCH spine center
Oct 15, 2009
¬ Patients characteristics• Average age: 57 yrs (36-76)• Average F/U: 21 m• Etiology