Residents' Learning Curve of Lumbar Transforaminal Epidural Steroid Injections.
Background and Study AimsThere is a paucity of literature on beginners' training and on its connection with patient safety for transforaminal epidural steroid injections (TFESIs). This study retrospectively assessed the learning curves and associated complications of neurosurgery residents never previously exposed to TFESI and compared them with experienced board-certified faculty neurosurgeons (BCFNs).Material and MethodsProcedure time in minutes, dose-area product (DAP) in cGy*cm2, periprocedural observations, and complications in 354 TFESIs for radicular pain secondary to lumbar disk herniation or lumbar spinal stenosis were extracted from operative notes and the electronic infiltration logbook in the per-injection format. Learning curves for 238 residents and 116 BCFN TFESIs in terms of procedure time and DAP were estimated using monotone regression.ResultsResidents' TFESI procedure time and DAP reached BCFN level (4.7 minutes and 140.2 Gy*cm2) after 67 and 68 cases, respectively. Residents' TFESIs were unsuccessful in 1.7%, mostly for severe obesity and hypertrophied facet joints, but no severe complications were noted. Obesity, however, did not result in increased procedure times or radiation exposure in general. Residents were faster and required less fluoroscopy in TFESI of the upper lumbar nerve roots than for L5 or S1 in particular.ConclusionThe residents' learning curve for TFESIs in terms of procedure time and radiation exposure can be overcome safely after < 70 TFESIs. An outcome analysis correlating to the interventionalist's training level would be worth investigating in future studies.
Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
Holger
H
Joswig
Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Sarah Roberta
SR
Haile
Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
Gerhard
G
Hildebrandt
Service de Neurochirurgie, Hôpitaux Universitaires de Genève, Genève, Switzerland.
Martin Nikolaus
MN
Stienen
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D007396:Internship and Residency; D055959:Intervertebral Disc Degeneration / Q000150:complications; D007405:Intervertebral Disc Displacement / Q000150:complications; D059032:Learning Curve; D017116:Low Back Pain / Q000188:drug therapy* / Q000209:etiology; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000193:education*; D012189:Retrospective Studies; D013130:Spinal Stenosis / Q000150:complications