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학제간연구 과학기술학 뇌인지과학 기술정책 기타 복합학

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논문 기본 정보

자료유형
학술저널
저자정보
Pravesh S. Gadjradj (Department of Neurological Surgery Weill Cornell Brain and Spine Center) Arnold Vreeling (Department of Orthopedic Surgery Rijnstate Ziekenhuis) Paul R. Depauw (Department of Neurosurgery Elisabeth-TweeSteden Ziekenhuis) Pieter J. Schutte (Department of Neurosurgery Alrijne Ziekenhuis) Biswadjiet S. Harhangi (Department of Neurosurgery Park Medical Center) PTED-Study Group (PTED-Study Group)
저널정보
대한척추신경외과학회 Neurospine Neurospine 제19권 제3호
발행연도
2022.9
수록면
594 - 602 (9page)
DOI
10.14245/ns.2244342.171

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초록· 키워드

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Objective: Full-endoscopic spine surgery is gaining interest as a less-invasive alternative to treat sciatica caused by a lumbar disc herniation. Concerns, however, exist with the learn ing curve as percutaneous transforaminal endoscopic discectomy (PTED) appears to be more difficult to be performed compared to other techniques. In this study, the clinical outcomes during and after the learning curve are presented of 3 surgeons naïve to PTED. Methods: In the first phase of a randomized controlled, noninferiority trial comparing PTED with microdiscectomy, 3 surgeons were trained in the PTED-procedure by a senior sur geon. After performing up to 20 cases under supervision, they started performing PTED on their own. Results of the early cases were compared to the later cases (>20). Further more, complications and reoperations were compared. Finally, differences in clinical out comes between surgeons were compared. Results: At 12 months of follow-up, 87% of the patients had follow-up data available. In general, there were no significant differences in patient-reported outcomes between the early and later PTED cases. Furthermore, outcomes of the early PTED cases were compa rable to the outcomes of microdiscectomy, while the later PTED cases had small, but more favorable outcomes compared to microdiscectomy. Two learning curve surgeons had sub stantially higher rates of reoperations within 1 year, compared to the senior surgeon or the microdiscectomy group. Duration of surgery was also longer for all learning curve sur geons. Finally, when comparing clinical outcomes of patients undergoing PTED versus mi crodiscectomy, there appears to be some statistically significant differences in outcomes compared between the senior and 3 learning curve surgeons. Conclusion: PTED appears to be safe to be adopted by surgeons naïve to the procedure when they are initially supervised by an experienced senior surgeon. Duration of surgery and risk of repeated surgery are increased during the learning curve, but patient-reported outcomes of the early PTED cases are similar to the outcomes of later PTED cases, and similar to the outcomes of microdiscectomy cases. This study underlines the need for an experienced mentor for surgeons to safely adopt PTED.
#Lumbar disc herniation #Endoscopic discectomy #Sciatica #Randomized con trolled trial

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