title: The learning curve of lateral access lumbar interbody fusion in an Asian population: a prospective study.
abstract: OBJECTIVE
  Lateral access lumbar interbody fusion (LLIF) is a minimally invasive technique that has an increasing popularity. It offers unique advantages and circumvents risk of certain serious complications encountered in other conventional spinal approaches. This study provides a statistical analysis defining the lateral access learning curve in the Asian population.
  
  
  METHODS
  This prospective study included 32 consecutive patients who underwent LLIF from April 2012 to August 2014. The surgeries were performed by two senior spine surgeons and follow-up was conducted at 6 weeks, 3, 6, 9 months and 1 year post-operation.
  
  
  RESULTS
  The breakpoint in operating time occurred at the 22nd level operated, from a mean of 71 min in the early phase group to a mean of 42 min in the steady state group. LLIF at L4/5 level is technically more demanding but technically feasible as competency is achieved.
  
  
  CONCLUSIONS
  During the learning process, there was no compromise of perioperative or clinical outcomes. It should be feasibly incorporated into a spine surgeon's repertoire of procedures for the lumbar spine.
authors.affiliation: Spine Surgery, Deptartment of Orthopedics, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore, 308433, Singapore, honglingng@aol.com.
authors.forename: Chong Leslie Lich
authors.initials: CL
authors.lastname: Ng
authors.forename: Boon Chuan
authors.initials: BC
authors.lastname: Pang
authors.forename: Paul Julius A
authors.initials: PJ
authors.lastname: Medina
authors.forename: Kimberly-Anne
authors.initials: KA
authors.lastname: Tan
authors.forename: Selvaraj
authors.initials: S
authors.lastname: Dahshaini
authors.forename: Li-Zhen
authors.initials: LZ
authors.lastname: Liu
mesh_terms: D044466:Asian People; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D059032:Learning Curve; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D061646:Operative Time; D011446:Prospective Studies; D012846:Singapore; D013123:Spinal Fusion / Q000379:methods*; D066231:Surgeons; D064232:Visual Analog Scale
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