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Learning Curve for Minimally Invasive Spine Surgery

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Minimally Invasive Spine Surgery

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Abstract

Minimally invasive spine surgery represents a fundamental shift in the way spine surgery is practiced. The minimally invasive approach has been applied in all aspects of spine surgery, from degenerative cases to complex deformity corrections. A challenge of minimally invasive spine surgery is the acquisition of the often unfamiliar skill set to perform the procedures. The procedures commonly require operating through narrow corridors and fluoroscopic visualization. This has led to the often stated “steep learning curve” in minimally invasive procedures. This chapter this will review a brief history of minimally invasive spine surgery, examine the learning curve in spine surgery, and explore methods to address the learning curve.

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Author information

Authors and Affiliations

  1. Mischer Neuroscience Associates, Houston, TX, USA

    Victor P. Lo

  2. Memorial Hermann Hospital, Houston, TX, USA

    Victor P. Lo

  3. University of Texas Health Science Center at Houston, Vivian L. Smith Department of Neurosurgery, Houston, TX, USA

    Victor P. Lo

  4. Department of Orthopedics/Spine, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Neel Anand

Authors
  1. Victor P. Lo
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  2. Neel Anand
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Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Frank M. Phillips

  2. Texas Back Institute Texas Health Presbyterian Hospital Plano Scoliosis and Spine Tumor Center, Plano, TX, USA

    Isador H. Lieberman

  3. Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA

    David W. Polly Jr.

  4. Department of Neurological Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL, USA

    Michael Y. Wang

Appendices

Quiz Questions

  1. 1.

    The learning curve for minimally invasive spine is often said to be steep. Explain why the statement is a misnomer. Please also describe the learning curve and identify the part of the curve where surgeons lie when learning minimally invasive spine surgical techniques.

  2. 2.

    List three methods described in the chapter to “bend” the learning curve. Describe how each method is important in facilitating the spine surgeon’s advancement along the learning curve.

Answers

  1. 1.

    In a graphical representation of the Ebbinghaus curve, the X-axis represents progression of time or number of attempts, and the Y-axis represents skill acquisition. In the initial segment, the learning curve slope is shallow, that is little is memorized with each trial. In the steep leg of the curve, significantly more is learned over a shorter time period. In the final segment, the curve is once again shallow, and the learning slows. Based on the Ebbinghaus learning curve, the steep portion of the curve is where learning is in fact the fastest. However, in learning new procedures or techniques such as MISS, the spine surgeon is actually at the shallow segment of the learning curve where there is slow progression over time.

  2. 2.

    A solid understanding of relational anatomy (i.e., anatomic structures that can directly be visualized as well as unseen), increased experience with two dimensional fluoroscopic view of spine anatomy, and appreciation of tactile feedback during the learning process. In addition, instructor-led cadaveric training may facilitate the learning curve by allowing the surgeon to observe and practice under the guidance of an experienced MISS surgeon in a safe environment.

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Lo, V.P., Anand, N. (2019). Learning Curve for Minimally Invasive Spine Surgery. In: Phillips, F., Lieberman, I., Polly Jr., D., Wang, M. (eds) Minimally Invasive Spine Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-19007-1_4

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  • DOI: https://doi.org/10.1007/978-3-030-19007-1_4

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-19006-4

  • Online ISBN: 978-3-030-19007-1

  • eBook Packages: MedicineMedicine (R0)

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