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"Learning curve"

Review Article

Minimally Invasive Spine Surgery

Evolving Paradigms in Spinal Surgery: A Systematic Review of the Learning Curves in Minimally Invasive Spine Techniques
Kun Wu, Zhihe Yun, Siravich Suvithayasiri, Yihao Liang, Dimas Rahman Setiawan, Vit Kotheeranurak, Khanathip Jitpakdee, Enrico Giordan, Qinyi Liu, Jin-Sung Kim
Neurospine 2024;21(4):1251-1275.   Published online December 31, 2024
DOI: https://doi.org/10.14245/ns.2448838.419

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Evolving Paradigms in Spinal Surgery: A Systematic Review of the Learning Curves in Minimally Invasive Spine Techniques
Neurospine. 2024;21(4):1251-1275.   Published online December 31, 2024
DOI: https://doi.org/10.14245/ns.2448838.419
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Evolving Paradigms in Spinal Surgery: A Systematic Review of the Learning Curves in Minimally Invasive Spine Techniques
Neurospine. 2024;21(4):1251-1275.   Published online December 31, 2024
DOI: https://doi.org/10.14245/ns.2448838.419
Close
Our research examines the learning curves of various minimally invasive lumbar surgeries to determine the benefits and challenges they pose to both surgeons and patients. The advent of microsurgical techniques since the 1960s, including advances in fluoroscopic navigation and intraoperative computed tomography, has significantly shifted spinal surgery from open to minimally invasive methods. This study critically evaluates surgical duration, intraoperative conversions to open surgery, and complications as primary parameters to gauge these learning curves. Through a comprehensive literature search up to March 2024, involving databases PubMed, Cochrane Library, and Web of Science, this paper identifies a steep learning curve associated with these surgeries. Despite their proven advantages in reducing recovery time and surgical trauma, these procedures require surgeons to master advanced technology and equipment, which can directly impact patient outcomes. The study underscores the need for well-defined learning curves to facilitate efficient training and enhance surgical proficiency, especially for novice surgeons. Moreover, it addresses the implications of technology on surgical accuracy and the subsequent effects on complication rates, providing insights into the complex dynamics of adopting new surgical innovations in spinal health care.

Citations

Citations to this article as recorded by  Crossref logo
  • Analgesia peridural caudal como manejo de dolor postquirúrgico en cirugía de columna lumbar: serie de 20 casos
    Marvin Gabriel Cruz Álvarez, Ana Lilia Guerrero Molina, Ozcar Felipe García López
    Cirugía de Columna.2026; 4(2): 85.     CrossRef
  • Eficacia y seguridad de técnicas mínimamente invasivas para la descompresión lumbosacra en pacientes con dolor radicular: análisis retrospectivo de hemilaminectomía, discectomía y técnica over-the-top en un hospital de segundo nivel
    Jorge Andrés Esparza Piña, Luis Mario Uribe
    Cirugía de Columna.2026; 4(2): 102.     CrossRef
  • Improvement in low back pain following endoscopic decompression for spinal stenosis
    Maria Auron, Yihyun Roh, Maria C. Pedraza Ciro, Win Boonsirikamchai, Yi-Hao Liang, Jung Hoon Kim, Jin-Sung Kim
    Brain and Spine.2026; 6: 105995.     CrossRef
  • A Systematic Review of Complication Management During Uniportal and Biportal Endoscopic Spine Surgery: Dural Tear and Bleeding
    Siravich Suvithayasiri, Ju Eun Kim, Facundo Van Isseldyk, Marcus Serra, Christopher Martin, Viswanadha Arunkumar, Sotirios Veranis, Prashanth Rao, Enrico Giordan, Piya Chavalparit, Nelson Astur, Samuel Cho, Jin Sung Kim
    Global Spine Journal.2026;[Epub]     CrossRef
  • Risk factors for surgical site infections after spinal surgery: a systematic review and meta-analysis
    Sophie-Liliane Rosenke, Myles Kisekka, Hiend Darweesh, Brawin Kajenthra, Jake Hewitt, Daniele Ramsay, Hariharan Subbiah Ponniah, Dragan Jankovic, Daniel Scurtu, Darius Kalasauskas, Andreas Kramer, Florian Ringel, Santhosh G. Thavarajasingam
    European Spine Journal.2026;[Epub]     CrossRef
  • Endoscopic resection of lumbar intradural spinal tumors: A case series on feasibility, safety, and preliminary outcomes
    Facundo Van Isseldyk, Vincent Hagel
    Brain and Spine.2026; 6: 106040.     CrossRef
  • Letter to the Editor regarding “Minimally Invasive Far Lateral Transforaminal Approach (MI-FLT) to ventrally located intradural lesions of the thoracic spine without instability: case series and technical note”
    Preeti Lamba
    Neurochirurgie.2026; 72(4): 101820.     CrossRef
  • O‐Arm Navigation Enhances Facet Preservation Without Compromising Clinical Outcomes in UBE Decompression for Radiographically Stable Adult Degenerative Scoliosis: A Single‐Center Comparative Study
    Yi Liu, Yiwei Xie, Zhibao Chen, Ruijun Xu, Haojie Chen, Xiaojian Ye, Jiangming Yu
    Orthopaedic Surgery.2026; 18(6): 1203.     CrossRef
  • Validation of the VIEW score: a novel intraoperative grading scale for visualization in endoscopic spine surgery
    Vit Kotheeranurak, Surachat Jaroenwareekul, Jin-Sung Kim, Christoph Siepe, Don Young Park, Javier Quillo-Olvera, Worawat Limthongkul, Wicharn Yingsakmongkol, Weerasak Singhatanadgige
    European Spine Journal.2026;[Epub]     CrossRef
  • Current Trends and Future Directions in Lumbar Spine Surgery: A Review of Emerging Techniques and Evolving Management Paradigms
    Gianluca Galieri, Vittorio Orlando, Roberto Altieri, Manlio Barbarisi, Alessandro Olivi, Giovanni Sabatino, Giuseppe La Rocca
    Journal of Clinical Medicine.2025; 14(10): 3390.     CrossRef
  • Prevalence and treatment outcomes of incidental dural tears in lumbar spine surgery
    M. Mofizur Rahman, Mohammad Abdul Hannan, M. Sarwar Jahan, Moniruzzaman Monir
    International Journal of Research in Orthopaedics.2025; 11(5): 991.     CrossRef
  • 13,285 View
  • 202 Download
  • 11 Web of Science
  • 11 Crossref

Original Articles

Special Issue on AI & Robotics

Robotic-Assisted Spine Surgery: Role in Training the Next Generation of Spine Surgeons
Jun Seok Lee, Dong Wuk Son, Su Hun Lee, Jong Hyeok Lee, Young Ha Kim, Sang Weon Lee, Bu Kwang Oh, Soon Ki Sung, Geun Sung Song, Seong Yi
Neurospine 2024;21(1):116-127.   Published online March 31, 2024
DOI: https://doi.org/10.14245/ns.2448006.003

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Robotic-Assisted Spine Surgery: Role in Training the Next Generation of Spine Surgeons
Neurospine. 2024;21(1):116-127.   Published online March 31, 2024
DOI: https://doi.org/10.14245/ns.2448006.003
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Robotic-Assisted Spine Surgery: Role in Training the Next Generation of Spine Surgeons
Neurospine. 2024;21(1):116-127.   Published online March 31, 2024
DOI: https://doi.org/10.14245/ns.2448006.003
Close
Objective
This study aimed to assess the degree of interest in robot-assisted spine surgery (RASS) among residents and to investigate the learning curve for beginners performing robotic surgery.
Methods
We conducted a survey to assess awareness and interest in RASS among young neurosurgery residents. Subsequently, we offered a hands-on training program using a dummy to educate one resident. After completing the program, the trained resident performed spinal fusion surgery with robotic assistance under the supervision of a mentor. The clinical outcomes and learning curve associated with robotic surgery were then analyzed.
Results
Neurosurgical residents had limited opportunities to participate in spinal surgery during their training. Despite this, there was a significant interest in the emerging field of robotic surgery. A trained resident performed RASS under the supervision of a senior surgeon. A total of 166 screw insertions were attempted in 28 patients, with 2 screws failing due to skiving. According to the Gertzbein-Robbins classification, 85.54% of the screws were rated as grade A, 11.58% as grade B, 0.6% as grade C, and 1.2% as grade D. The clinical acceptance rate was approximately 96.99%, which is comparable to the results reported by senior experts and time per screw statistically significantly decreased as experience was gained.
Conclusion
RASS can be performed with high accuracy within a relatively short timeframe, if residents receive adequate training.

Citations

Citations to this article as recorded by  Crossref logo
  • Spinale Robotik vs. Cone-Beam-Navigation
    Patrick Strube, Alexander Hölzl, Anna-Maria Vogel, Georg Matziolis, Chris Lindemann
    Die Orthopädie.2026;[Epub]     CrossRef
  • A Comprehensive Review of the Role of the Latest Minimally Invasive Neurosurgery Techniques and Outcomes for Brain and Spinal Surgeries
    Simone Laguardia, Alessio Piccioni, Jorge Eduardo Alonso Vera, Ali Muqaddas, Milko Garcés, Sidra Ambreen, Sarmishtha Sharma, Tara Sabzvari
    Cureus.2025;[Epub]     CrossRef
  • Visuohaptic Feedback in Robotic-Assisted Spine Surgery for Pedicle Screw Placement
    Giuseppe Loggia, Fedan Avrumova, Darren R. Lebl
    Journal of Clinical Medicine.2025; 14(11): 3804.     CrossRef
  • Robot-assisted versus navigated spinal fusion surgery: a comparative multicenter study on transpedicular screw placement accuracy and patient outcomes
    Giada Garufi, Gianluca Scalia, Francesca Graziano, Roberta Costanzo, Massimiliano Porzio, Giancarlo Ponzo, Massimiliano Giuffrida, Giuseppe Ricciardo, Giuseppe Emmanuele Umana, Giovanni Federico Nicoletti, Salvatore Massimiliano Cardali
    Neurosurgical Review.2025;[Epub]     CrossRef
  • Evolving Paradigms in Spine Surgery Training: Integrating Technology, Ethics, and Minimally Invasive Techniques
    G. Balamurali, Soma Sundar Subramanian, Keerthivasan Panneerselvam
    Journal of Minimally Invasive Spine Surgery and Technique.2025; 10(Suppl 2): S107.     CrossRef
  • Robot-Assisted Pedicle Screw Insertion in Pediatric Spine Surgery: An Institutional Experience and Meta-Analysis
    Taha Khalilullah, Abdul Karim Ghaith, Xinlan Yang, Linda Tang, Shaan Bhandarkar, Meghana Bhimreddy, Arjun D. Menta, Daniel Davidar, Andrew Hersh, Carly Weber-Levine, Kelly Jiang, Patrick Kramer, Ritvik Jillala, Maria Jennings, Jawad M. Khalifeh, Tej D. Az
    Operative Neurosurgery.2025;[Epub]     CrossRef
  • Commentary on “The Utility and Feasibility of Smart Glasses in Spine Surgery: Minimizing Radiation Exposure During Percutaneous Pedicle Screw Insertion”
    Wongthawat Liawrungrueang
    Neurospine.2024; 21(2): 440.     CrossRef
  • 9,206 View
  • 180 Download
  • 6 Web of Science
  • 7 Crossref
Learning Curve and Complications of Unilateral Biportal Endoscopy: Cumulative Sum and Risk-Adjusted Cumulative Sum Analysis
Jinchao Xu, Dong Wang, Jidan Liu, Chengyue Zhu, Jianhang Bao, Wenshuo Gao, Wei Zhang, Hao Pan
Neurospine 2022;19(3):792-804.   Published online August 15, 2022
DOI: https://doi.org/10.14245/ns.2143116.558

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Learning Curve and Complications of Unilateral Biportal Endoscopy: Cumulative Sum and Risk-Adjusted Cumulative Sum Analysis
Neurospine. 2022;19(3):792-804.   Published online August 15, 2022
DOI: https://doi.org/10.14245/ns.2143116.558
Download Citation

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Learning Curve and Complications of Unilateral Biportal Endoscopy: Cumulative Sum and Risk-Adjusted Cumulative Sum Analysis
Neurospine. 2022;19(3):792-804.   Published online August 15, 2022
DOI: https://doi.org/10.14245/ns.2143116.558
Close
Objective
The purpose of this study was to investigate the learning curve and complications of unilateral biportal endoscopy (UBE) in the treatment of lumbar disc herniation (LDH) and lumbar spinal stenosis (LSS).
Methods
This was a retrospective cohort analysis of 197 consecutive patients who received UBE unilateral laminotomy bilateral decompression (UBE-ULBD) or lumbar discectomy (UBE-LD) surgery, including 107 males and 90 females with an average age of 64.83 ± 14.29 years. Cumulative sum (CUSUM) and risk-adjusted cumulative sum analysis (RA-CUSUM) were used to evaluate the learning curve, with the occurrence of complications defined as surgical failure, and variables of different phase of the learning curve were compared.
Results
The cutoff point of learning curve of UBE surgery was 54 cases according to CUSUM analysis. The learning curve of UBE-ULBD and UBE-LD were divided into 3 phases. The first cutoff points were 31 and 12 cases, and the second cutoff point were 67 and 32 cases respectively. With the progress of the learning curve, the operation time and postoperative hospital stays decreased. The visual analogue scale and Oswestry Disability Index at the last follow-up were significantly lower than that before surgery. The incidence of surgical failure was 6.11% and began to decrease after the 89th case based on RA-CUSUM analysis. The surgical failure rate decreased from 10.11% to 2.78 after the 89th case with significant different.
Conclusion
UBE surgery is effective in the treatment of LDH and LSS with low incidence of complications. But a learning curve of at least 54 cases still required for mastering UBE surgery.

Citations

Citations to this article as recorded by  Crossref logo
  • Comparison of the Biportal Endoscopic Versus Tubular Approach for the Treatment of Lumbar Degenerative Disease: A Systematic Review and Meta-Analysis
    Mark Kurapatti, Alexander Yu, Hamza Ahmed, Charu Jain, Ryan Hoang, Gray W. Ricca, Junho Song, Daniel Berman, Joshua Lee, Samuel K. Cho
    Global Spine Journal.2026; 16(1): 794.     CrossRef
  • Learning Curve of Unilateral Biportal Endoscopy in Spinal Stenosis: A Neuromonitoring-Assisted Analysis
    Ali Gulec, Ebubekir Eravsar, Sadettin Ciftci, Selim Safali, Ali Özdemir, Fatih Durgut, Bahattin Kerem Aydin
    Global Spine Journal.2026; 16(1): 707.     CrossRef
  • Comparing Unilateral Biportal Endoscopic Discectomy Versus Microdiscectomy for Lumbar Disc Herniation: A Systematic Review and Meta-Analysis
    Muhammad Hassan Waseem, Zain ul Abideen, Muneeba Ahsan, Rimsha Adnan, Arusha Hasan, Zoya Aamir, Mahrosh Kasbati, Pawan Kumar Thada, Brandon Lucke-Wold
    Global Spine Journal.2026; 16(5): 2452.     CrossRef
  • Meta-Analysis of Complications in Minimally Invasive Spine Surgery (2013–2024)
    Sean Inzerillo, Eesha Gurav, Chibuikem A. Ikwuegbuenyi, Noah Willett, Mousa Hamad, Ibrahim Hussain, Alan Hernández-Hernández, Galal Elsayed, Roger Härtl, Osama Kashlan
    Spine.2026; 51(3): E47.     CrossRef
  • The learning curve of percutaneous endoscopic interlaminar discectomy versus unilateral biportal endoscopic discectomy for lumbar disc herniation: a comparative study
    Jin Chen, Lisi Zhang, Zhihan Wang, Li Liu, Lei Wang
    Journal of Orthopaedic Surgery and Research.2026;[Epub]     CrossRef
  • Automated Surgical Phase Recognition in Unilateral Biportal Endoscopic Spine Surgery Using Deep Learning
    Takahiro Kitagawa, Yoshiomi Kobayashi, Keitaro Matsukawa, Shogo Hashimoto, Reo Shibata, Mitsuru Furukawa, Tsunehiko Konomi, Kanehiro Fujiyoshi, Yoshiyuki Yato, Masaya Nakamura
    Spine Open.2026;[Epub]     CrossRef
  • Complications and their prevention in unilateral biportal endoscopy: a systematic review with narrative insights and practical management algorithms
    Xavier A. Santander, Martin N. Stienen, Stefan Motov, Héctor U. Quintanilla, Elsa González Pérez
    Acta Neurochirurgica.2026;[Epub]     CrossRef
  • Efficacy and safety of unilateral biportal endoscopy vs. percutaneous endoscopic interlaminar approach in lumbar disc herniation: A meta‑analysis​
    Yuhao Gao, Fangzheng He, Ji Wen, Shilei Qin, Pengfei Han, Yunfeng Xu
    Experimental and Therapeutic Medicine.2026; 31(3): 1.     CrossRef
  • Anatomical Validation and Technical Feasibility of Biportal Endoscopic Spinal Surgery Including Technical Notes in a Cadaveric Canine Thoracic Intervertebral Disc Disease Model
    Sung-Ho Lee, Ji-Hyun Park, Da-Eun Kim, Gunha Hwang, Chang-Hwan Moon, Dongbin Lee
    Animals.2026; 16(3): 435.     CrossRef
  • A retrospective study on the effects of unilateral biportal endoscopic lumbar interbody fusion on functional recovery in patients undergoing single-level lumbar interbody fusion
    Xinyun Huang, Shi Ling, Qi Cao
    Translational Neuroscience.2026;[Epub]     CrossRef
  • Comparative Cost Analysis
    Kern Singh, Andrea M. Roca, Fatima N. Anwar, Shriya N. Patel, Sloane O. Ward, Daniel K. Park
    Clinical Spine Surgery.2026;[Epub]     CrossRef
  • Minimally invasive spine surgery: current advantages, limitations, and future directions
    Weonmin Cho, Soo-Bin Lee, Seong Ho Oh, Young-Seo Park, Kyung-Yil Kang
    Asian Spine Journal.2026;[Epub]     CrossRef
  • Percutaneous transforaminal endoscopic discectomy vs. unilateral biportal endoscopy for far lateral lumbar disc herniation: a retrospective comparative study
    Lu Yongjiang, Li Chunbo, Wang Jianyuan
    Frontiers in Surgery.2026;[Epub]     CrossRef
  • Comparison of outcomes after unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy for lumbar disc herniation: a systematic review and meta-analysis of observational studies
    Abdullah Afridi, Ayesha Zulfiqar, Muhammad Waqar Shahid, Fatima Sajjad, Hamnah Sohail, Fazia Khattak, Sabir Khan, Ayesha Naseem, Alina Batool, Muhammad Muneeb, Savira Khattak, Izhar Ul Haq, Ayesha Shahid, Ayesha Nauman, Marium Nisar, Tanveer Hussain, Ahsa
    Egyptian Journal of Neurosurgery.2026;[Epub]     CrossRef
  • O‐Arm Navigation Enhances Facet Preservation Without Compromising Clinical Outcomes in UBE Decompression for Radiographically Stable Adult Degenerative Scoliosis: A Single‐Center Comparative Study
    Yi Liu, Yiwei Xie, Zhibao Chen, Ruijun Xu, Haojie Chen, Xiaojian Ye, Jiangming Yu
    Orthopaedic Surgery.2026; 18(6): 1203.     CrossRef
  • Clinical outcomes of uni-portal non-coaxial spinal endoscopic surgery versus unilateral biportal endoscopic surgery for lumbar spinal stenosis: a retrospective cohort study
    Xiao Min Cai, Guo Sen Li, Xiao Yang Nie, Da Liu, Chun Lin Xiao, Min Zhao, En Song, Jiang Jun Zhou
    Frontiers in Surgery.2026;[Epub]     CrossRef
  • БИПОРТАЛЬНАЯ ЭНДОСКОПИЧЕСКАЯ ХИРУРГИЯ. КЛИНИЧЕСКИЕ РЕЗУЛЬТАТЫ ОПЕРАТИВНОГО ЛЕЧЕНИЯ 250 БОЛЬНЫХ С ПАТОЛОГИЕЙ ПОЗВОНОЧНИКА
    В.В. Ступак, Ш.А. Аул, А.Г. Бобылев, Ж.И. Жалолов, А.А. Абдурохмонов, О.И. Кузиев, М.В. Куценко, В.В. Кельмаков
    Современные проблемы науки и образования (Modern Problems of Science and Education).2026; (№5 2026): 26.     CrossRef
  • Early Clinical and Radiologic Evaluation of Unilateral Biportal Endoscopic Unilateral Laminotomy and Bilateral Decompression in Degenerative Lumbar Spinal Stenosis: A Retrospective Study
    Jianjian Yin, Tao Ma, Gongming Gao, Qi Chen, Luming Nong
    Journal of Neurological Surgery Part A: Central European Neurosurgery.2025; 86(05): 428.     CrossRef
  • Learning Curve of Endoscopic Lumbar Discectomy – A Systematic Review and Meta-Analysis of Individual Participant and Aggregated Data
    Chan Hee Koh, James Booker, David Choi, Danyal Zaman Khan, Hugo Layard Horsfall, Parag Sayal, Hani J Marcus, George Prezerakos
    Global Spine Journal.2025; 15(2): 1435.     CrossRef
  • Short-term efficacy of unilateral biportal endoscopy technology in the treatment of cervical spondylotic radiculopathy
    Mohan Wen, Xu Li, Xiangjun Lu, Tianzuo Chen, Rujie Qin
    European Spine Journal.2025; 34(1): 118.     CrossRef
  • Comparative Study Between Unilateral Biportal Endoscopic Discectomy and Percutaneous Interlaminar Endoscopic Discectomy for the Treatment of L5/S1 Disc Herniation
    Jianjian Yin, Gongming Gao, Senlin Chen, Tao Ma, Luming Nong
    World Neurosurgery.2025; 194: 123526.     CrossRef
  • Learning curve insights in Unilateral Biportal Endoscopic (UBE) spinal procedures: proficiency cutoffs and the impact on efficiency and complications
    Jing Peng, Rongzhen Lin, Duopei Fang, Zhaojun He, Qinghao Zhao, Qingchu Li
    European Spine Journal.2025; 34(3): 954.     CrossRef
  • Delta large-channel endoscopy versus unilateral biportal endoscopy decompressive laminectomy for lumbar spinal stenosis: a prospective randomized controlled trial
    Rushuo Wei, Weiqiang Liu, Mingdong Yu, Yushan Zhu, Ruzhan Yao, Bingwu Wang, Jesse Li-Ling
    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
  • Unilateral biportal endoscopic discectomy for lumbar disc herniation: Learning curve analysis with CUSUM analysis and clinical outcomes
    Oğuz Kağan Demirtaş, Mehmet İlker Özer
    Clinical Neurology and Neurosurgery.2025; 249: 108755.     CrossRef
  • Clinical and Radiological Comparison of Unilateral Biportal Endoscopic and Percutaneous Transforaminal Endoscopic Discectomy in the Treatment of Lumbar Spinal Degenerative Disease
    Hongtao Ding, Xiao Han, Yonggang Xing, Yajun Liu, Da He, Xiaoguang Han
    Orthopaedic Surgery.2025; 17(4): 1105.     CrossRef
  • What is the learning curve for endoscopic spine surgery? A comprehensive systematic review
    Justin P. Chan, Thomas Olson, Beshoy Gabriel, Sohaib Hashmi, Hao-Hua Wu, Hansen Bow, Yu-Po Lee, Nitin Bhatia, Michael Oh, Don Y Park
    The Spine Journal.2025;[Epub]     CrossRef
  • Comparison of Learning Curves and Clinical Outcomes in Unilateral Biportal Endoscopic Spinal Surgery Versus Percutaneous Transforaminal Endoscopic Surgery: A Cumulative Sum Analysis
    Shuo Yuan, Ruiyuan Chen, Yuqi Mei, Ning Fan, Tianyi Wang, Aobo Wang, Peng Du, Yu Xi, Lei Zang
    Journal of Pain Research.2025; Volume 18: 631.     CrossRef
  • Biportal Versus Uniportal Lumbar Decompression—Indications and Efficacy: A Review With Case Examples
    Felicia W. Sun, Ki-Eun Chang, Jian Shen, Albert E. Telfeian
    Neurosurgery.2025; 96(3S): S63.     CrossRef
  • Safety and Utility of Bilateral-contralateral Decompression for Adjacent Segment Stenosis After Lumbar Interbody Fusion Using Unilateral Biportal Endoscopy
    Dong Hyun Lee, Choon Keun Park, Jae-Won Jang, Dong-Geun Lee
    Clinical Spine Surgery.2025; 38(10): E488.     CrossRef
  • Learning curve for full-endoscopic lumbar decompression via interlaminar approach using the learning curve cumulative summation analysis
    Sung Cheol Park, Sang-Min Park, Hoon-Jae Chung, Yong Jin You
    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
  • Clinical Efficacy of Biportal versus Uniportal Endoscopic Discectomy for Far Lateral Lumbar Disc Herniation: A Retrospective Study Analysis
    Zhang Zhiqiang, Yang Jiandong, Huang Zhi, Abdiaziz Ahmed Mohamed, Zhang Liang, Feng Xinmin
    World Neurosurgery.2025; 197: 123788.     CrossRef
  • The learning curve for lumbar discectomy in unilateral biportal endoscopic spine surgery using the cumulative summation method
    Takaki Yoshimizu, Sanshiro Saito, Teruaki Miyake, Tetsutaro Mizuno, Ushio Nosaka, Keisuke Ishii, Mizuki Watanabe, Kanji Sasaki
    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
  • A retrospective study on safety and clinical outcomes of unilateral biportal endoscopic technique for spinal degenerative diseases
    Haitao Sun, Qi Zhang, Kehan Xu, Zihuan Zhou, Dongjie Jiang, Shaohui He, Jilu Liu, Haifeng Wei
    PeerJ.2025; 13: e19076.     CrossRef
  • Transforaminal Endoscopic Thoracic Discectomy Is More Cost-Effective Than Microdiscectomy for Symptomatic Disc Herniations
    Junseok Bae, Pratyush Shahi, Sang-Ho Lee, Han-Joong Keum, Ju-Wan Seok, Yong-Soo Choi, Jin-Sung Kim
    Neurospine.2025; 22(1): 118.     CrossRef
  • Unilateral Biportal Endoscopic Spinal Surgery: Comparing Clinical Outcomes and Learning Curves between Novice and Experienced Surgeons
    Shou-En Cheng, Jwo-Luen Pao, Yu-Hung Chen
    Formosan Journal of Musculoskeletal Disorders.2025; 16(2): 69.     CrossRef
  • The unilateral biportal endoscopy journey: proposing a 10-tier difficulty progression framework for unilateral biportal endoscopy
    Xavier Augusto Santander, Elsa González Pérez, Dae-Jung Choi
    Asian Spine Journal.2025; 19(2): 311.     CrossRef
  • Comparison of surgical outcomes between unilateral biportal endoscopic technique and open microdiscectomy in patients with single-level lumbar disc herniation: a single-center retrospective study in China
    Tianyao Ke, Qiulin He, Qiying Wang, Long Li, Changgui Shi, Jiaxue Zeng, Qing Li
    Asian Spine Journal.2025; 19(4): 600.     CrossRef
  • Learning Curve Analysis: Impact of Ligamentum Flavum Removal Methods on Unilateral Biportal Endoscopic Laminectomy for Lumbar Spinal Stenosis
    Woo Hyeong Joe, Sae min Kwon, Chang-Young Lee, Chang-Hyun Kim, Min-Yong Kwon, Jae Hyun Kim, In soo Kim, Young San Ko
    Journal of Minimally Invasive Spine Surgery and Technique.2025; 10(1): 131.     CrossRef
  • Biportal endoscopic lumbar interbody fusion using a large polyetheretherketone cage: preliminary results
    Sang-Min Park, Hyun-Jin Park, Ki-Han You, Ho-Joong Kim, Jin S. Yeom
    Asian Spine Journal.2025; 19(2): 252.     CrossRef
  • Unilateral Biportal Endoscopic Discectomy via the Contralateral Sublaminar Approach for Lumbar Disc Herniation with Very High-Grade Migration: A Technical Note and Case Series
    Yong Jin Park, Man Kyu Park, Sang Kyu Son, Young San Ko
    World Neurosurgery.2025; 197: 123939.     CrossRef
  • Comparative study of the learning curves for percutaneous endoscopic interlaminar lumbar discectomy and unilateral biportal endoscopy techniques
    Weidong Guo, Shikong Guo, Xiaoping Zhang, Weiliang Zhang, Guifeng Xia, Bo Liao
    BMC Surgery.2025;[Epub]     CrossRef
  • Comparison of percutaneous endoscopic lumbar discectomy (PELD) and unilateral biportal endoscopic (UBE) discectomy in the treatment of far lateral lumbar disc herniation (FLLDH): a retrospective study
    Liang Li, Jilong An, Lei Guo, Xiuqi Shan, Yapeng Sun, Jiaqi Li, Fei Zhang, Wei Zhang
    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
  • The usefulness and utilisation of Lu’s retractor for unilateral biportal endoscopic discectomy: a retrospective cohort study
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    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
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Learning Curve of ROSA ONE Spine System for Transpedicular Screw Placement
Bing-Hung Hsu, Heng-Wei Liu, Kha-Liang Lee, Ming-Chin Lin, Gao Chen, Jang Yu, Chiao-Ling Chen, I-Chang Su, Chien-Min Lin
Neurospine 2022;19(2):367-375.   Published online May 12, 2022
DOI: https://doi.org/10.14245/ns.2143126.563

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Learning Curve of ROSA ONE Spine System for Transpedicular Screw Placement
Neurospine. 2022;19(2):367-375.   Published online May 12, 2022
DOI: https://doi.org/10.14245/ns.2143126.563
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Learning Curve of ROSA ONE Spine System for Transpedicular Screw Placement
Neurospine. 2022;19(2):367-375.   Published online May 12, 2022
DOI: https://doi.org/10.14245/ns.2143126.563
Close
Objective
The study investigated our institutional learning curve for the ROSA ONE spine system (ROSA) based on ROSA usage time.
Methods
ROSA was designed to provide high accuracy for spinal pedicle screw placement through a built-in tracking technique. This study was conducted from November 2018 to January 2021. The time taken to complete each step of the robotic workflow was recorded. Patient demographics, comorbidities, surgical indications, and number of screw placements were examined in subgroup analysis. The Curve Fitting-General package (a part of NCSS 2021 software) was used to fit a mathematical model to the learning curve. Patient demographics, imaging data, and surgical time were reviewed retrospectively.
Results
A total of 167 patients who had undergone surgery were included. The mean total ROSA usage time was 107.1 ± 27.3 minutes. The estimated learning rate was 90.4%, and the largest slope change occurred close to the time of the 20th surgery. The observed overall learning trend in the 4-screw group could be attributed to screw planning. The presence of scoliosis (p = 0.73) or spondylolisthesis (p = 0.70) did not significantly influence the mean total time (TT) for all patients; however, the mean TT differed significantly (p < 0.01) among subgroups stratified by body mass index, screw number placement, and thoracic spine involvement.
Conclusion
To the best of our knowledge, this is the first study to examine the learning curve for the various crucial steps of ROSA-guided pedicle screw placement. The indicative learning curve involved 20 patients who had undergone surgery.

Citations

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    Conor McNamee, David Kelly, Jake M. McDonnell, Aubrie M. Sowa, Anushka Menon, Stacey Darwish, Joseph S. Butler
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  • First experience with a novel image guidance technology for posterior pedicle screw fixation: A cadaveric study on 2D/3D registration-based spine surgery
    Benno Bullert, Jula Gierse, Eric Mandelka, Holger Freischmidt, Kornelis Poelstra, Paul Alfred Gruetzner, Sven Yves Vetter
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    Kelly Jiang, Andrew M. Hersh, Meghana Bhimreddy, Carly Weber-Levine, A. Daniel Davidar, Arjun K. Menta, Denis Routkevitch, Safwan Alomari, Brendan F. Judy, Daniel Lubelski, Jon Weingart, Nicholas Theodore
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    Byeong-Jin Ha, Jong-Min Lee, Seon-Jin Yoon, Byung-Kwan Kim, Junseok Lee, Suhun Lee, Seungjae Ryu, Yongyeob Cha, Sungteac Hwang, Donggi Woo, Chang Kyu Lee, Dong Ah Shin, Yoon Ha, Sung Uk Kuh, Keung Nyun Kim, Dongwuk Son, Seong Yi
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    Neurospine.2023; 20(4): 1256.     CrossRef
  • 7,754 View
  • 228 Download
  • 18 Web of Science
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Percutaneous Endoscopic Decompression in Lumbar Canal and Lateral Recess Stenosis – The Surgical Learning Curve
Chul-Woo Lee, Kang-Jun Yoon, Sung-Won Kim
Neurospine 2019;16(1):63-71.   Published online March 31, 2019
DOI: https://doi.org/10.14245/ns.1938048.024

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Percutaneous Endoscopic Decompression in Lumbar Canal and Lateral Recess Stenosis – The Surgical Learning Curve
Neurospine. 2019;16(1):63-71.   Published online March 31, 2019
DOI: https://doi.org/10.14245/ns.1938048.024
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Percutaneous Endoscopic Decompression in Lumbar Canal and Lateral Recess Stenosis – The Surgical Learning Curve
Neurospine. 2019;16(1):63-71.   Published online March 31, 2019
DOI: https://doi.org/10.14245/ns.1938048.024
Close
Objective
The purpose of this study is to characterize the learning curve of endoscopic lumbar decompression based on peri- and postoperative parameters and to suggest the potential of full endoscopic decompression as a primary treatment option for lumbar canal and lateral recess stenosis.
Methods
The records of 223 consecutive patients who underwent percutaneous endoscopic decompression by a single surgeon for their lumbar canal and lateral recess stenosis were reviewed. Patients were stratified into group 1 (n=100) and group 2 (n=123), depending on their case number. After the 100th case, the procedural time reached a plateau and subsequent patients were assigned to the second group. Demographics and surgical outcomes, including operative times, change in dural sac dimensions, length of hospital stay, and intraoperative complication rates were compared between the 2 groups. Postoperative clinical outcomes, including the visual analogue scale (VAS), the Oswestry Disability Index (ODI) and reoperation rates were compared between the 2 groups (group 1, n=90; group 2, n=110) by follow-up evaluation.
Results
Procedural times were greater in group 1 than group 2 (group 1, 105.26 minutes; group 2, 67.65 minutes; p<0.05) and they had higher complication rates (group 1, 16% [16 of 100]; group 2, 8.3% [8 of 123]; p<0.05). The length of hospitalization, postoperative improvement in VAS and ODI, and reoperation rates were not different between the groups. In both groups, stenotic spinal canals were effectively decompressed.
Conclusion
Continued surgical experience was associated with a reduction in operative times and less intraoperative complications. Although the learning curve was steep and additional surgical experience may be needed to overcome the learning curve, percutaneous full endoscopic lumbar decompression is a safe, clinically-feasible, and effective surgical technique and can be adopted as the primary treatment for lumbar canal and lateral recess stenosis.

Citations

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    European Spine Journal.2024; 33(11): 4171.     CrossRef
  • Full endoscopic percutaneous stenoscopic lumbar decompression and discectomy: An outcome and efficacy analysis on 606 lumbar stenosis patients
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    Conor McNamee, Salman Keraidi, Jake McDonnell, Andrew Kelly, Julia Wall, Stacey Darwish, Joseph S. Butler
    The Spine Journal.2024; 24(10): 1789.     CrossRef
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    Frontiers in Surgery.2024;[Epub]     CrossRef
  • Preliminary Clinical and Radiological Outcomes of the “No-Punch” Decompression Techniques for Unilateral Biportal Endoscopic Spine Surgery
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    Neurospine.2024; 21(2): 732.     CrossRef
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    BMC Musculoskeletal Disorders.2024;[Epub]     CrossRef
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    Coluna/Columna.2024;[Epub]     CrossRef
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    Vo Van Thanh, Nguyen Le Bao Tien, Dao Xuan Thanh, Ngo Thanh Tu, Nguyen Viet Luc, Pham Hong Phong, Nguyen Vu Cong Bao Long, Le Thanh Dung, Dinh Ngoc Son, Nguyen Hoang Long, Vu Van Cuong, Do Manh Hung, Nguyen Van Thach, Nguyen Duc Nghia, Le Manh Thuong, Tra
    Journal of the Anatomical Society of India.2024; 73(3): 249.     CrossRef
  • Full-endoscopic lumbar spine surgery using working-channel endoscopes: technical tips for practical effectiveness
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    Expert Review of Medical Devices.2024; 21(12): 1131.     CrossRef
  • Evolving Paradigms in Spinal Surgery: A Systematic Review of the Learning Curves in Minimally Invasive Spine Techniques
    Kun Wu, Zhihe Yun, Siravich Suvithayasiri, Yihao Liang, Dimas Rahman Setiawan, Vit Kotheeranurak, Khanathip Jitpakdee, Enrico Giordan, Qinyi Liu, Jin-Sung Kim
    Neurospine.2024; 21(4): 1251.     CrossRef
  • Modified facet joint fusion for multilevel lumbar spinal stenosis: a retrospective study of 135 consecutive patients
    Wenfang Dong, Zhinan Ren, Shugang Li
    British Journal of Neurosurgery.2023; 37(5): 1046.     CrossRef
  • Retrospective Case Control Study: Clinical and Computer Tomographic Fusion and Subsidence Evaluation for Single Level Uniportal Endoscopic Posterolateral Approach Transforaminal Lumbar Interbody Fusion Versus Microscopic Minimally Invasive Transforaminal
    Hyeun Sung Kim, Pang Hung Wu, Ji Yeon Kim, Jun Hyung Lee, Yeon Jin Lee, Dae Hwan Kim, Jun Hyung Lee, Jun Bok Jeon, Il-Tae Jang
    Global Spine Journal.2023; 13(2): 304.     CrossRef
  • Increased Surgeon-specific Experience and Volume is Correlated With Improved Clinical Outcomes in Lumbar Fusion Patients
    Kevin Hines, Lucas Philipp, Sara Thalheimer, Thiago S. Montenegro, Glenn A. Gonzalez, Liam P. Hughes, Adam Leibold, Aria Mahtabfar, Daniel Franco, Joshua E. Heller, Jack Jallo, Srinivas Prasad, Ashwini D. Sharan, James S. Harrop
    Clinical Spine Surgery.2023; 36(2): E86.     CrossRef
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    Saad Moughal, Michael C. Quaye, Salima Wahab, Jonathan Hempenstall, Colin Griffith, Jason Harvey, Kyriakos Giannoulis, Stephen McGillion, Emad Shenouda, Nicholas Brooke, Ali Nader-Sepahi, Christopher J. Dare, Anan Shtaya
    European Spine Journal.2023; 32(2): 475.     CrossRef
  • Identification of preoperative radiological risk factors for reoperation following percutaneous endoscopic lumbar decompression to treat degenerative lumbar spinal stenosis
    Aobo Wang, Tianyi Wang, Lei Zang, Ning Fan, Shuo Yuan, Fangda Si, Peng Du
    Frontiers in Surgery.2023;[Epub]     CrossRef
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    Yuehang Sheng, Jing Li, Lei Chen, Minghao Geng, Jing Fen, Shaodong Sun, Jianhua Sun
    BMC Musculoskeletal Disorders.2023;[Epub]     CrossRef
  • Impact of the learning curve of percutaneous endoscopic lumbar discectomy on clinical outcomes: a systematic review
    Rohaid Ali, Matthew J Hagan, Ankush Bajaj, J.N. Alastair Gibson, Christoph P. Hofstetter, Albrecht Waschke, Kai-Uwe Lewandrowski, Albert E. Telfeian
    Interdisciplinary Neurosurgery.2023; 32: 101738.     CrossRef
  • Case-matched radiological and clinical outcome evaluation of interlaminar versus microsurgical decompression of lumbar spinal stenosis
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    European Spine Journal.2023; 32(8): 2863.     CrossRef
  • Complications and Management of Endoscopic Spinal Surgery
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    Neurospine.2023; 20(1): 56.     CrossRef
  • Advancing Education in Endoscopic Spinal Navigation: Novel Methods and Technical Note
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    Cureus.2023;[Epub]     CrossRef
  • Uniportal versus biportal endoscopic spine surgery: a comprehensive review
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    Expert Review of Medical Devices.2023; 20(7): 549.     CrossRef
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    Journal of Personalized Medicine.2023; 13(10): 1508.     CrossRef
  • Lumbar Endoscopic Unilateral Laminotomy With Bilateral Decompression Surgery in Severe Lumbar Stenosis Under Electrophysiological Monitoring-Focused on Full-Visualized Trephine/Osteotome
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    Neurospine.2023; 20(3): 1040.     CrossRef
  • Technical Notes of Full Endoscopic Lumbar Interbody Fusion with Anterior Expandable Cylindrical Fusion Cage: Clinical and Radiographic Outcomes at 1-Year Follow-Up
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    World Neurosurgery.2022; 158: e618.     CrossRef
  • Remodeling Pattern of Spinal Canal after Full Endoscopic Uniportal Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression: One Year Repetitive MRI and Clinical Follow-Up Evaluation
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    Diagnostics.2022; 12(4): 793.     CrossRef
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    Journal of Musculoskeletal Research.2022;[Epub]     CrossRef
  • Full-endoscopic versus microscopic unilateral laminotomy for bilateral decompression of lumbar spinal stenosis at L4–L5: comparative study
    Kuo-Tai Chen, Kyung-Chul Choi, Hyeong-Ki Shim, Dong-Chan Lee, Jin-Sung Kim
    International Orthopaedics.2022; 46(12): 2887.     CrossRef
  • Early Readmission and Reoperation After Percutaneous Transforaminal Endoscopic Decompression for Degenerative Lumbar Spinal Stenosis: Incidence and Risk Factors
    Aobo Wang, Fangda Si, Tianyi Wang, Shuo Yuan, Ning Fan, Peng Du, Lei Wang, Lei Zang
    Risk Management and Healthcare Policy.2022; Volume 15: 2233.     CrossRef
  • Complications of Unilateral Biportal Endoscopic Lumbar Discectomy: A Systematic Review
    Yi-Syuan Li, Chien-Min Chen, Chien-Jen Hsu, Zhi-Kang Yao
    World Neurosurgery.2022; 168: 359.     CrossRef
  • Contraindications and Complications of Full Endoscopic Lumbar Decompression for Lumbar Spinal Stenosis: A Systematic Review
    Chang-Il Ju, Pius Kim, Sang-Woo Ha, Seok-Won Kim, Seung-Myung Lee
    World Neurosurgery.2022; 168: 398.     CrossRef
  • Comparison Between Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression and Other Decompression Approaches for Lumbar Spinal Stenosis: A Systematic Review
    Po-Lin Chiang, Ying-Yu Chen, Ko-Ta Chen, Jason C. Hsu, Christopher Wu, Ching-Yu Lee, Tsung-Jen Huang, Yi-Hung Huang, Chien-Min Chen, Meng-Huang Wu
    World Neurosurgery.2022; 168: 369.     CrossRef
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    Neurospine.2022; 19(4): 1028.     CrossRef
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    Hyeun Sung Kim, Pang Hung Wu, Yeon Jin Lee, Dae Hwan Kim, Il Tae Jang
    World Neurosurgery.2021; 145: 682.     CrossRef
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    World Neurosurgery.2021; 145: 663.     CrossRef
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    World Neurosurgery.2021; 145: 708.     CrossRef
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    Interdisciplinary Neurosurgery.2021; 23: 100963.     CrossRef
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    Journal of Pain Research.2020; Volume 13: 1377.     CrossRef
  • Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion with Endoscopic Disc Drilling Preparation Technique for Symptomatic Foraminal Stenosis Secondary to Severe Collapsed Disc Space: A Clinical and Computer Tomographic Study with
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    Brain Sciences.2020; 10(6): 373.     CrossRef
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    Medicine.2020; 99(29): e21049.     CrossRef
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    Neurospine.2020; 17(Suppl 1): S3.     CrossRef
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    Hyeun-Sung Kim, Pang Hung Wu, Il-Tae Jang
    Neurospine.2020; 17(Suppl 1): S99.     CrossRef
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    Neurospine.2020; 17(Suppl 1): S20.     CrossRef
  • Early Career Challenges in Setting Up an Endoscopic Spine Surgery Practice
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    Bei‐xi Bao, Jian‐wei Zhou, Pan‐Feng Yu, Cheng Chi, Hua Qiang, Hui Yan
    Orthopaedic Surgery.2019; 11(6): 1093.     CrossRef
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