Outcomes and Complications Associated with the Learning Curve for Endoscopic Cervical Foraminotomy: A Systematic Review and Meta-Analysis.
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2023-10
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Systematic review and meta-analysis.Objective
The objective of this study is to examine the impact of the learning curve for endoscopic cervical foraminotomy for clinical outcomes and patient safety.Summary of background data
Endoscopic cervical foraminotomy is a minimally invasive surgical technique emerging in the literature for surgical management of cervical radiculopathy without the use of open incision. The adoption of endoscopic cervical foraminotomy may be hindered by the learning curve, although no review and meta-analysis exists to date on the topic.Methods
A systematic review and meta-analysis was performed using PubMed, CINAHL, and MEDLINE from database inception until July 11th, 2023. Inclusion criteria were articles that examined endoscopic cervical foraminotomy, reported outcomes and/or complications for endoscopic cervical spine surgery relevant to the learning curve and had full-text. A random effects meta-analysis was performed for outcomes and complications.Results
A total of three articles (n=203 patients) were included from 792 articles initially retrieved. The learning curves from four surgeons were examined with a frequency weighted mean 21 procedures until the competency phase. There was no significant difference in the postoperative hospitalization length (P=0.669), postoperative recovery room time (P=0.415), intraoperative blood loss (P=0.064), and total complication rates (10.9% vs. 1.2%, P=0.139) between endoscopic cervical foraminotomy procedures performed in the learning phase as compared to the competency phase of the learning curve. There was a significant decrease in operative time from the learning phase to the competency phase (P=0.005).Conclusion
Competency was achieved on the learning curve for endoscopic cervical foraminotomy after about 21 procedures. There is no significant difference in postoperative hospitalization time, postoperative recovery room time, intraoperative blood loss, and complication rates between the learning phase and the competency phase of the learning curve for endoscopic cervical foraminotomy, noting the relatively small sample size of this study that may underpower this finding.Type
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Baumann, Anthony N, Megan E Callaghan, Kempland C Walley, Albert T Anastasio, Aditya Muralidharan, Grayson Talaski and Brett Rocos (2023). Outcomes and Complications Associated with the Learning Curve for Endoscopic Cervical Foraminotomy: A Systematic Review and Meta-Analysis. Spine. 10.1097/brs.0000000000004859 Retrieved from https://hdl.handle.net/10161/29682.
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Brett Rocos
I joined the team at Duke University Health from London, UK, where I was a Consultant Adult and Paediatric Spine Surgeon at Barts Health NHS Trust and Honorary Consultant Senior Lecturer at Queen Mary University of London. I completed my surgical training in in the South West of the UK and at the University of Toronto, and am fellowship trained in adult spine surgery, paediatric spine surgery, orthopaedic trauma surgery, research and healthcare management.
I am driven to support patients at every stage of their care, from clinic assessment, through surgery to discharge. Making sure that every person, adult, child, family or friend understands what’s wrong, helping them to choose the right treatment for them, and what the recovery will be like is an important priority.
My research activity focusses on finding effective new treatments for spinal disorders and bringing them to patients. Focusing on spinal deformity, I have led investigations in the UK, Canada and the USA, and I sit on the Global AO Knowledge Forum for Deformity and the Research Grants Committee at the Scoliosis Research Society. I have lectured in North America and Europe about the treatment of spine disorders for the Scoliosis Research Society, Global Spine Congress, AO Spine and Eurospine, and I have worked hard to produce research that improves the care for spine patients wherever they live. Lastly, I review for several orthopaedic journals and I am Deputy Editor of the Bone and Joint 360, a leading publication with a global readership.
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