title: Influence of surgical experience on the efficiency of discectomy in TLIF: a cadaveric testing in 40 levels.
abstract: METHODS
  Cadaveric study.
  
  
  OBJECTIVE
  The purpose of this study was to assess the influence of surgical experience on the efficiency of lumbar discectomy in open transforaminal lumbar interbody fusion.
  
  
  BACKGROUND
  There is limited knowledge about the efficiency of discectomy among surgeons. As a first study, we are evaluating the effect of surgical experience on it.
  
  
  METHODS
  Manual and powered discectomies were randomized and performed by 3 attending spine surgeons and 2 clinical spine fellows. Each discectomy procedure was analyzed for the area of complete endplate preparation, total elapsed time, and number of instrument passes. The surface area of discectomy at each endplate was measured utilizing digital imaging and the appropriate software. For the purpose of the analysis, the superior and the inferior endplates were divided into ipsilateral and contralateral halves, and each half was further divided into ventral and dorsal quadrants. Each quadrant was analyzed in a blinded manner by 2 observers.
  
  
  RESULTS
  A total of 40 discectomies were performed on 9 fresh-frozen cadaveric torsos between the levels T12 and S1. A powered discectomy device was used in levels 9 and 11 by the attendings. Manual discectomy was performed in 11 levels by the spine fellows and 9 by the spine attendings. No significant difference was observed between the spine fellows and spine attendings when the manual instruments were used (P = 0.924). However, the spine attending surgeon group had a significantly increased total area of discectomy compared with the fellows (P = 0.003). No significant difference was observed between the groups when instrument passes or the total elapsed time were compared either utilizing the manual or the powered technique.
  
  
  CONCLUSIONS
  Our results demonstrate that a satisfactory discectomy may be performed by surgeons with relatively less surgical experience in the transforaminal approach using a powered discectomy device.
authors.affiliation: Spine and Scoliosis Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA. matthiaspumberger@gmail.com
authors.forename: Matthias
authors.initials: M
authors.lastname: Pumberger
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Hughes
authors.forename: Federico P
authors.initials: FP
authors.lastname: Girardi
authors.forename: Jaspaul
authors.initials: J
authors.lastname: Gogia
authors.forename: Suhel Y
authors.initials: SY
authors.lastname: Kotwal
authors.forename: Christoph
authors.initials: C
authors.lastname: Thaler
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Sama
mesh_terms: D002102:Cadaver; D017586:Diskectomy / Q000295:instrumentation / Q000379:methods; D005257:Fellowships and Scholarships; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery* / Q000648:ultrastructure; D008505:Medical Staff, Hospital; D019060:Minimally Invasive Surgical Procedures; D009985:Orthopedics; D011361:Professional Competence; D016684:Prone Position; D011897:Random Allocation; D016037:Single-Blind Method; D013123:Spinal Fusion / Q000379:methods; D013997:Time Factors