Learning Curve of Microendoscopic Discectomy in Single-Level Prolapsed Intervertebral Disc in 120 Patients

Abstract

Study Design: Retrospective study of prospectively collected data. Objective: To evaluate learning curve of tubular microendoscopic discectomy (MED) in lumbar prolapsed intervertebral disc (PIVD) patients based on surgical and clinical parameters and delineate the challenges faced in early cases while practicing MED in large series of patients. Methods: This study was an institutional review board–approved retrospective study of the first 125 consecutive patients with single-level lumbar PIVD managed with tubular MED from 2008 to 2016 with a minimum 2-year follow-up. A total of 120 patients available at final follow-up were divided into quartiles (30 each) as per the date of surgery, with each consecutive group serving as a control for the previous group. Preoperatively and postoperatively clinical parameters (pain scores [Visual Analogue Scale; VAS], functional disability [Oswestry Disability Index; ODI] score, modified MacNab criteria), perioperative parameters (operative time, blood loss, hospital stay), technical issues (guide wire migration, tube docking–related problems, dural tear), and postoperative complications (postoperative leg pain, neural injury, infection, recurrence) were evaluated. Statistical analysis—logarithm curve-fit regression analysis and ANOVA test. Results: The sample consisted of 75 males and 45 females (mean age: 42.54 years) with no significant difference among the quartiles. There was significant difference (P