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Study Design <p>Prospective single-center observational cohort study.</p> Objectives <p>To assess whether prior arthroscopic experience is associated with a shorter learning curve in <b>uniportal interlaminar endoscopic lumbar discectomy (IELD)</b>, primarily in terms of operative efficiency, and to descriptively evaluate perioperative complications and patient-reported outcomes.</p> Methods <p>In accordance with STROBE guidelines, 240 consecutive patients with single-level lumbar disc herniation (MSU A/B, non-calcified, symptom duration ≤ 3 months) underwent IELD between 2021 and 2023 at a single academic orthopedic center. Procedures were performed by three spine surgeons without prior endoscopic experience; one surgeon had performed more than 300 shoulder arthroscopies. Operative time was analyzed using cumulative sum (CUSUM) methodology and linear regression. Missing outcome data were handled using last observation carried forward. Complications were recorded descriptively and stratified by learning phase and surgeon. Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores for back and leg pain were assessed preoperatively and at 3 and 12 months.</p> Results <p>All surgeons demonstrated a three-phase learning curve consisting of learning, improvement, and stabilization phases. Operative efficiency stabilized after approximately 50 cases across surgeons. The surgeon with prior arthroscopic experience reached the CUSUM inflection point earlier (case 12) compared with the other surgeons (cases 24–26). The overall major complication rate was 9.2% and was highest during the initial learning phase. ODI and VAS scores improved significantly at 3 and 12 months (all <i>p</i> &lt; 0.001), with no statistically significant between-surgeon differences at final follow-up.</p> Conclusions <p>Prior arthroscopic experience was <b>associated with earlier adaptation during the initial learning phase</b> of IELD, as measured by operative time. Following procedural stabilization, no statistically significant differences were detected in operative efficiency, major complication rates, or patient-reported outcomes between surgeons. These findings suggest that arthroscopic experience may facilitate early adaptation to endoscopic visualization and workflow but does not independently determine long-term clinical outcomes.</p> Level of Evidence <p>III</p>

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Impact of arthroscopic experience on the learning curve in interlaminar endoscopic lumbar discectomy: a single-center prospective cohort study of 240 patients

  • 期刊论文

  • 发表日期：

    2026年1月28日

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  • Tomasz Sienkiel,
  • Marcin Gąska,
  • Przemysław Koszyk,
  • Ewa Lipik,
  • Barbara Jasiewicz

摘要

Study Design

Prospective single-center observational cohort study.

Objectives

To assess whether prior arthroscopic experience is associated with a shorter learning curve in uniportal interlaminar endoscopic lumbar discectomy (IELD), primarily in terms of operative efficiency, and to descriptively evaluate perioperative complications and patient-reported outcomes.

Methods

In accordance with STROBE guidelines, 240 consecutive patients with single-level lumbar disc herniation (MSU A/B, non-calcified, symptom duration ≤ 3 months) underwent IELD between 2021 and 2023 at a single academic orthopedic center. Procedures were performed by three spine surgeons without prior endoscopic experience; one surgeon had performed more than 300 shoulder arthroscopies. Operative time was analyzed using cumulative sum (CUSUM) methodology and linear regression. Missing outcome data were handled using last observation carried forward. Complications were recorded descriptively and stratified by learning phase and surgeon. Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores for back and leg pain were assessed preoperatively and at 3 and 12 months.

Results

All surgeons demonstrated a three-phase learning curve consisting of learning, improvement, and stabilization phases. Operative efficiency stabilized after approximately 50 cases across surgeons. The surgeon with prior arthroscopic experience reached the CUSUM inflection point earlier (case 12) compared with the other surgeons (cases 24–26). The overall major complication rate was 9.2% and was highest during the initial learning phase. ODI and VAS scores improved significantly at 3 and 12 months (all p < 0.001), with no statistically significant between-surgeon differences at final follow-up.

Conclusions

Prior arthroscopic experience was associated with earlier adaptation during the initial learning phase of IELD, as measured by operative time. Following procedural stabilization, no statistically significant differences were detected in operative efficiency, major complication rates, or patient-reported outcomes between surgeons. These findings suggest that arthroscopic experience may facilitate early adaptation to endoscopic visualization and workflow but does not independently determine long-term clinical outcomes.

Level of Evidence

III