Learning Curve of Biportal Endoscopic Spinal Surgery: A Retrospective 2-Center Study

Abstract

OBJECTIVEBiportal endoscopic spinal surgery (BESS) technique is a novel, useful and minimally invasive therapeutic strategy for lumbar degenerative diseases, which has advantages over other surgical techniques. However, the degree of technical difficulty in learning BESS is controversial and not well established. This study aims to determine the learning curve of BESS technique through cumulative sum (CUSUM) analysis. METHODSA total of 144 consecutive patients who underwent BESS with lumbar decompressive discectomy between 2017 and 2023 were included. A retrospective bi-center study was performed. RESULTSThree doctors with endoscopy experience employed the BESS technique for 51, 42 and 46 procedures, respectively. The CUSUM test of the three doctors showed adequate technical ability at the 45th, 41st and 44th operations respectively. Two doctors without endoscopy experience gave up further use of BESS technique due to technical difficulties after initial attempt. The overall complication rates of the three surgeons using the BESS technique were 3.92% (n = 2), 6.82% (n = 3), and 2.17% (n = 1), respectively. CONCLUSIONSOur study demonstrated that BESS is an effective treatment, and the learning curves of BESS for lumbar discectomy using CUSUM analysis were 41 ∼ 45 cases in trainees with endoscopic experience. Endoscopic experience contributes to the learning curve of the BESS technique.