Does Arthroscopic Experience Shorten the Learning Curve in Endoscopic Lumbar Discectomy? A Prospective Cohort of 240 Patients

Does Arthroscopic Experience Shorten the Learning Curve in Endoscopic Lumbar Discectomy? A Prospective Cohort of 240 Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Does Arthroscopic Experience Shorten the Learning Curve in Endoscopic Lumbar Discectomy? A Prospective Cohort of 240 Patients Tomasz Sienkiel, Marcin Gąska, Przemysław Koszyk This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7728146/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Study Design : Prospective observational cohort study. Objectives : To evaluate whether prior arthroscopic experience accelerates the learning curve in interlaminar endoscopic lumbar discectomy (IELD) and influences complication rates and patient-reported outcomes (PROs). Methods : A total of 240 consecutive patients with symptomatic lumbar disc herniation (MSU A/B, non-calcified, symptom duration ≤3 months) underwent single-level IELD performed by three endoscopy-naïve spine surgeons; one had previously performed >300 shoulder arthroscopies. Operative times were analyzed using CUSUM and linear regression, with stabilization defined as ≥3 consecutive cases within ±10% of each surgeon’s mean time. Complications were stratified by type, phase, and surgeon. ODI and VAS (back/leg) were recorded preoperatively and at 3 and 12 months. Results : All surgeons demonstrated a three-phase pattern (learning, improvement, stabilization). Surgeons without arthroscopic background exited the learning phase at ~case 25 and stabilized by case 49–53, while the arthroscopy-experienced surgeon improved by case 12. Mean operative times at stabilization were 39.8, 39.3, and 45.6 minutes. Neurological complications (nerve-root injuries, n=4; dural tears, n=3) occurred exclusively in the learning phase (p=0.024). Recurrent herniations (n=15) were phase-independent (p=0.62). All groups showed significant improvement in ODI and VAS at 3 and 12 months (p<0.001), with no differences between surgeons at final follow-up. Conclusions : IELD is safe and effective, but early neurological risk is learning-dependent. Prior arthroscopic experience markedly shortens the learning curve and may lower perioperative risk, without altering long-term PROs. These findings highlight the potential role of arthroscopic skill transfer in endoscopic spine training curricula. Level of Evidence : III endoscopic spine surgery lumbar discectomy learning curve arthroscopy skill transfer CUSUM Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7728146","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":529013923,"identity":"fc2aad4c-7463-46f3-aa56-4db4c299c573","order_by":0,"name":"Tomasz 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A Prospective Cohort of 240 Patients","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"endoscopic spine surgery, lumbar discectomy, learning curve, arthroscopy, skill transfer, CUSUM","lastPublishedDoi":"10.21203/rs.3.rs-7728146/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7728146/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e: Prospective observational cohort study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e: To evaluate whether prior arthroscopic experience accelerates the learning curve in interlaminar endoscopic lumbar discectomy (IELD) and influences complication rates and patient-reported outcomes (PROs).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A total of 240 consecutive patients with symptomatic lumbar disc herniation (MSU A/B, non-calcified, symptom duration ≤3 months) underwent single-level IELD performed by three endoscopy-naïve spine surgeons; one had previously performed \u0026gt;300 shoulder arthroscopies. Operative times were analyzed using CUSUM and linear regression, with stabilization defined as ≥3 consecutive cases within ±10% of each surgeon’s mean time. Complications were stratified by type, phase, and surgeon. ODI and VAS (back/leg) were recorded preoperatively and at 3 and 12 months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: All surgeons demonstrated a three-phase pattern (learning, improvement, stabilization). Surgeons without arthroscopic background exited the learning phase at ~case 25 and stabilized by case 49–53, while the arthroscopy-experienced surgeon improved by case 12. Mean operative times at stabilization were 39.8, 39.3, and 45.6 minutes. Neurological complications (nerve-root injuries, n=4; dural tears, n=3) occurred exclusively in the learning phase (p=0.024). Recurrent herniations (n=15) were phase-independent (p=0.62). All groups showed significant improvement in ODI and VAS at 3 and 12 months (p\u0026lt;0.001), with no differences between surgeons at final follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: IELD is safe and effective, but early neurological risk is learning-dependent. Prior arthroscopic experience markedly shortens the learning curve and may lower perioperative risk, without altering long-term PROs. These findings highlight the potential role of arthroscopic skill transfer in endoscopic spine training curricula.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLevel of Evidence\u003c/strong\u003e: III\u003c/p\u003e","manuscriptTitle":"Does Arthroscopic Experience Shorten the Learning Curve in Endoscopic Lumbar Discectomy? 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