6 key notes on the ACDF learning curve: Can surgeons safely perform it in the beginning of their career?


A new study published in Spine examines the learning curve for anterior cervical discectomy and fusion.

The researchers examined a prospectively maintained surgical database with one- and two-level primary ACDF patients for degenerative disease who underwent spinal fusion from 2006 to 2014. There were 374 patients included in the study that began after the surgeon's fellowship. There were 125 patients placed in the "early" group, 125 in the "middle" group and 124 in the "late" group.


The researchers found:


1. The surgeon's early cohort included more patients with greater comorbidity, higher percentage of smokers and Medicare patients when compared with later cohorts. There were also fewer workers' compensation patients.


2. The later cohorts had lower average operative time and estimated blood loss.


3. The later cohorts reported an increased arthrodesis rate when compared with the early cohort. The arthrodesis rate is expected to increase over a longer period of time after operative proficiency is achieved.


4. There was a 50 percent learning curve at case 17 in the asymptomatic regression analysis and case 31 at the linear regression analysis. The study authors concluded operative proficiency is expected by case 60.


5. There was a 90 percent potential improvement by case 56 in the asymptomatic regression analysis and case 57 in the linear regression analysis.


6. Despite the learning curve and longer operative times, the study authors concluded ACDF is a safe procedure for surgeons to perform early in their career.


"A significant learning curve exists for surgeons performing ACDFs," concluded the study authors. "Patients undergoing ACDF will experience shorter operations, less EBL and greater arthrodesis rates as the surgeon gains experience."


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