Our Summary

In this study, researchers wanted to figure out how long it takes for a surgeon to get good at a specific type of spine surgery called biportal endoscopic spinal surgery (BESS). The surgeon in question had experience with other types of spine surgery, but had never performed BESS before.

The researchers used a special type of analysis called LC-CUSUM to track the surgeon’s progress. They defined a successful surgery as one that took less than 75 minutes - this is the usual time it takes for a similar surgery using a microscope.

They studied the first 60 surgeries that the surgeon performed and found that on average, the surgeries took about 84 minutes. In the surgeon’s early learning period (first 30 surgeries), the average time was around 105 minutes. In the later learning period (next 30 surgeries), the average time dropped to about 62 minutes. The overall rate of complications was about 10%.

The LC-CUSUM analysis showed that the surgeon was competent at performing BESS by the 58th surgery. In other words, it took about 58 surgeries for the surgeon to get good at this new technique.

In conclusion, this study shows that it may take a substantial amount of time and practice for a surgeon to get proficient at performing lumbar decompressive laminectomy using BESS.

FAQs

  1. What is biportal endoscopic spinal surgery (BESS)?
  2. How long did it take for the surgeon to become proficient in BESS according to the LC-CUSUM analysis?
  3. What was the average time it took for the surgeon to perform the surgery during the early and later learning periods?

Doctor’s Tip

A doctor may advise a patient undergoing spinal laminectomy to choose a surgeon who has experience and proficiency in performing the specific type of surgery being recommended. It may be beneficial to ask the surgeon about their experience with the procedure and how many surgeries they have performed successfully. This can help ensure a better outcome and reduce the risk of complications.

Suitable For

Patients who may be recommended spinal laminectomy include those with spinal stenosis, herniated discs, spinal cord compression, and other conditions that cause pressure on the spinal cord or nerves. It is typically recommended for patients who have not responded to non-surgical treatments such as physical therapy, medications, and injections. Additionally, patients who have symptoms such as severe pain, weakness, numbness, and difficulty walking may benefit from spinal laminectomy. It is important for patients to discuss their specific condition and treatment options with their healthcare provider to determine if spinal laminectomy is the best course of action for them.

Timeline

Before the spinal laminectomy:

  1. Patient experiences symptoms such as back pain, leg pain, numbness, or weakness.
  2. Patient undergoes diagnostic tests such as X-rays, MRI, or CT scans to determine the cause of their symptoms.
  3. Patient consults with a spine surgeon to discuss treatment options, including spinal laminectomy.
  4. Surgery is scheduled and patient receives pre-operative instructions.

After the spinal laminectomy:

  1. Patient undergoes the spinal laminectomy procedure, which involves removing a portion of the lamina (the bony arch of the vertebra) to relieve pressure on the spinal cord or nerves.
  2. Patient is monitored in the recovery room before being transferred to a hospital room or discharged home.
  3. Patient may experience some pain and discomfort after the surgery, which can be managed with pain medication.
  4. Physical therapy and rehabilitation may be recommended to help the patient regain strength and mobility.
  5. Follow-up appointments are scheduled to monitor the patient’s recovery and address any concerns.
  6. Patient gradually resumes normal activities and experiences improvement in their symptoms over time.

What to Ask Your Doctor

Some questions a patient should ask their doctor about spinal laminectomy include:

  1. How many spinal laminectomies have you performed using the specific technique planned for my surgery?
  2. What is your success rate with spinal laminectomy surgeries, and how do you define success?
  3. What are the potential complications or risks associated with spinal laminectomy surgery?
  4. How long is the typical recovery time after a spinal laminectomy procedure?
  5. What alternative treatment options are available for my condition, and why do you recommend spinal laminectomy for me?
  6. Will I need physical therapy or rehabilitation after the surgery, and if so, what does that entail?
  7. What can I expect in terms of pain management following the surgery?
  8. What lifestyle changes or restrictions should I follow after the surgery to promote healing?
  9. How often will I need follow-up appointments after the surgery, and what will those appointments involve?
  10. Are there any specific warning signs or symptoms I should watch for after the surgery that may indicate a complication?

Reference

Authors: Park SM, Kim HJ, Kim GU, Choi MH, Chang BS, Lee CK, Yeom JS. Journal: World Neurosurg. 2019 Feb;122:e1007-e1013. doi: 10.1016/j.wneu.2018.10.197. Epub 2018 Nov 4. PMID: 30404053