. 2020 Dec 17;2020:8815432.
doi: 10.1155/2020/8815432.
eCollection 2020.
Affiliations
Affiliations
- 1 Department of Orthopedic Surgery, Himnaera Hospital, Busan, Republic of Korea.
- 2 Department of Orthopedic Surgery, Daegu Fatima Hospital, Daegu, Republic of Korea.
- 3 Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
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Ju-Eun Kim et al.
Biomed Res Int.
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. 2020 Dec 17;2020:8815432.
doi: 10.1155/2020/8815432.
eCollection 2020.
Affiliations
- 1 Department of Orthopedic Surgery, Himnaera Hospital, Busan, Republic of Korea.
- 2 Department of Orthopedic Surgery, Daegu Fatima Hospital, Daegu, Republic of Korea.
- 3 Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
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Abstract
Interbody fusion is a common surgical technique for diseases of the lumbar spine. Biportal endoscopic-assisted lumbar interbody fusion (BE-LIF) is a novel minimally invasive technique that has a long learning curve, which can be a barrier for surgeons. Therefore, we analyzed the learning curve in terms of operative time and evaluated the outcomes of BE-LIF. A retrospective study of fifty-seven consecutive patients who underwent BE-LIF for degenerative lumbar disease by a single surgeon from January 2017 to December 2018 was performed. Fifty patients underwent a single-level procedure, and 7 underwent surgery at two levels. The mean follow-up period was 24 months (range, 14-38). Total operative time, postoperative drainage volume, time to ambulation, and complications were analyzed. Clinical outcome was measured using the Oswestry Disability Index (ODI), Visual Analog Scale (VAS) score for back and leg pain, and modified Macnab criteria. The learning curve was evaluated by a nonparametric regression locally weighted scatterplot smoothing curve. Cases before the stable point on the curve were designated as group A, and those after the stable point were designated group B. Operative time decreased as the number of cases increased. A stable point was noticed on the 400th day and the 34th case after the first BE-LIF was performed. All cases showed improved ODI and VAS scores at the final follow-up. Overall mean operative time was 171.74 ± 35.1 min. Mean operative time was significantly lower in group B (139.7 ± 11.6 min) compared to group A (193.4 ± 28.3 min). Time to ambulation was significantly lower in group B compared to group A. VAS and ODI scores did not differ between the two groups. BE-LIF is an effective minimally invasive technique for lumbar degenerative disease. In our case series, this technique required approximately 34 cases to reach an adequate performance level.
Copyright © 2020 Ju-Eun Kim et al.
Conflict of interest statement
The authors declare that there is no conflict of interest regarding the publication of this paper.
Figures

Figure 1
Intraoperative endoscopic views of the…
Figure 1
Intraoperative endoscopic views of the disc space. (a) Double-ended elevator used to denude…
Intraoperative endoscopic views of the disc space. (a) Double-ended elevator used to denude the superior endplate of the caudal vertebra. (b) Denuded inferior endplate of the cranial vertebra. (c) Denuded superior and inferior endplates of the disc space (caudally tilted view). (d) Denuded superior and inferior endplate of the disc space (cranially tilted view).

Figure 2
Bone graft and cage insertion.…
Figure 2
Bone graft and cage insertion. (a) A funnel is used to insert bone…
Bone graft and cage insertion. (a) A funnel is used to insert bone graft inside the disc space. (b) Posteroanterior fluoroscopic view of the funnel positioned inside the disc space. (c) Cage inserted under endoscope guidance. (d) Lateral fluoroscopic view during the cage insertion.

Figure 3
Perioperative plain radiography films. (a)…
Figure 3
Perioperative plain radiography films. (a) Preoperative anteroposterior and lateral images show degenerative L3–4…
Perioperative plain radiography films. (a) Preoperative anteroposterior and lateral images show degenerative L3–4 spondylolisthesis. (b) Follow-up anteroposterior and lateral films showing reduction of sagittal alignment. (c) Sagittal computed tomography image 14 months postoperatively showing trabecular bridging without endplate disruption or cage subsidence.

Figure 4
A nonparametric regression locally weighted…
Figure 4
A nonparametric regression locally weighted scatterplot smoothing curve of operative time and day…
A nonparametric regression locally weighted scatterplot smoothing curve of operative time and day after the first biportal endoscopic-lumbar interbody fusion case (a, b). The slope of operative time flattened after the 34th case and 400th day.

Figure 5
Pain and functional scores. The…
Figure 5
Pain and functional scores. The values between the 2 groups at each time…
Pain and functional scores. The values between the 2 groups at each time point did not show a significant difference. (a) VAS leg score significantly improved after surgery. (b) VAS back score significantly improved after surgery. (c) ODI score significantly improved after surgery (VAS: Visual Analog Scale; ODI: Oswestry Disability Index).
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