Learning Curve and Minimally Invasive Spine Surgery

BACKGROUND: Minimally invasive surgery has become popular in recent times and has proved more advantageous than conventional open surgery methods, in terms of maximal preservation of natural anatomy and minimal postoperative complications. However, these advancements require a longer learning curve for inexperienced surgeons. OVERVIEW: The learning curve in minimally invasive spine surgery is complex and difficult to measure, and therefore operating times, conversion to open procedures, visual analog scale, and periods of hospital stay are used. In assessing complications as a measure of the learning curve, it was noted that nearly all the complications had been documented previously and became minimum after the 30th consecutive case. As surgical experience increases, perioperative parameters (e.g., operative time and length of hospitalization) improve. The downside of minimally invasive spine surgery is starting unfamiliar procedures without tactile sensation, working in a narrow restricted surgical field, and using endoscopes via two-dimensional imaging. CONCLUSIONS: Appropriate instruments, a trained team, and an adept radiographer are important assets for a smooth transition during the learning period. Structured training with cadavers and lots of practice, preferably while working under the guidance of experienced surgeons, is helpful. The learning curve can be shortened when a proficient surgeon gains relevant knowledge, understands three-dimensional anatomy, and has surgical aptitude along with manual dexterity.