A Learning Curve Analysis of Post Operative Complications in Endoscopic Lumbar Interlaminar Discectomy: A Single Institutional Study

Introduction: Endoscopic Lumbar Interlaminar Discectomy (ELID) has emerged as a minimally invasive surgical technique for addressing thoracic disc herniations, offering a promising alternative to traditional open procedures. As with any surgical innovation, the evolution of surgical techniques and the accumulation of experience among practitioners have the potential to significantly impact patient outcomes. In the context of ETID, the relationship between surgeon experience and complications remains an important and evolving area of investigation.

Methods: This paper utilized a retrospective cohort analysis to investigate endoscopic spine procedures from Houston Methodist Hospital from 2020 to 2023. Cohorts were developed based on when the procedure was performed, with procedures done prior to September of 2022 considered as past procedures and those done after September of 2022 considered at recent procedures. A chi-squared analysis and univariate logistic regression were used to analyze which complications were statistically significant between groups.

Results: The two learning curve groups consisted of the first 49 and last 49 patients to undergo ELID. Comparison of the two learning curve groups via Pearson’s chi-squared test found no statistically significant difference between the two groups in either length of stay or complications. Average length of stay after surgery reduced from 0.51 hours to 0.31 hours in the recent group but was not statistically significant (p = 0.166). Complications present in either group were postoperative radiculopathy, bleeding (hematoma), return to OR (within 90 days), readmission (within 90 days) and other radiculopathy. Bleeding (hematoma) was the only complication present in the before group only (1 case in 49), however this was not statistically significant (p = 0.315).

Conclusion : Our results show no differences in length of stay and complications between early ELID and later ELID. Large, multicenter prospective studies are needed to evaluate the learning curves for endoscopic transforaminal discectomy.