The popularity of endoscopic surgery of the lumbar spine has increased exponentially over the last few years, linked to less surgical aggressiveness and early return to daily activities. The primary aim of this study was to assess if there was a clinical impact of the learning curve for the percutaneous endoscopy discectomy (PED). Demographic and clinical data from patients who underwent PED due to lumbar disc herniation, between May 2019 and June 2022 was collected. 45 patients were included. We used the transforaminal approach in 51.1% of the patients while the remaining were through an interlaminar window. The median duration of surgery was 84 minutes (Interquartile range (IQR) of 68-92 minutes). As the surgeon acquired more experience, the duration of the surgery decreased, which was particularly expressive for the transforaminal approach. No relation was found between surgery duration and obesity (p=0.725). Only one patient required conversion to open surgery and it was the same that had a dural injury. We had to re-operate 2 cases (4.4%). No positive correlation was found between the VAS score and the duration of surgery (p=0.312) and between surgery duration and clinical recurrence (p=0.211). Pain persistence was more common in patients with depression (p=.009). The learning curve for PED can be successfully overcome without introducing a significant risk for patients. The transforaminal approach demonstrates more significant progression, while the interlaminar approach exhibits a more plateau-like pattern.
Almeida et al. (Sun,) studied this question.