STUDY DESIGN: Retrospective review of prospectively collected data. OBJECTIVE: To describe the learning curve for percutaneous transforaminal endoscopic discectomy (PTED) and demonstrate its efficacy in treating lumbar disc herniation. SUMMARY OF BACKGROUND DATA: The learning curve for PTED has not yet been standardized in the literature. METHODS: Consecutive patients who underwent lumbar PTED by a single surgeon between December 2020-2022 were included. Cumulative Sum (CuSum) analysis was applied to operative and fluoroscopy time to assess the learning curve. Inflection points were used to divide cases into early and late phases. The two phases were analyzed for differences in operative and fluoroscopy time, length of stay, complications, and patient-reported outcome measures (PROMs). Patient characteristics and operated levels were also compared. PROMs entailed the Oswestry Disability Index, Patient-Reported Outcomes Measurement Information System, Visual Analog Scale Back/Leg, and 12-Item Short Form Survey at preoperative, early postoperative (<6 mo), and late postoperative (≥6 mo) timepoints. PROMs between PTED cases and a comparable cohort of tubular microdiscectomy (TM) cases performed by the same surgeon were compared. RESULTS: 55 patients were included. CuSum analysis indicated that both operative and fluoroscopy time diminished rapidly after case 31, suggesting a learning curve of 31 cases (Early Phase n=31; Late Phase n=24). Late-phase cases exhibited significantly lower operative times (85.7 vs. 62.2 min, P=0.001) and fluoroscopy times (131.0 vs. 97.2 seconds, P=0.001) compared to the early-phase cases. Both early- and late-phase cases showed significant improvement in all PROMs. There were no differences in PROMs between the PTED and TM patients. CONCLUSION: The PTED learning curve was found to be 31 cases and did not impact PROMs or complication rates. Although this learning curve reflects the experiences of a single surgeon and may not be broadly applicable, PTED can serve as an effective modality for treatment of lumbar disc herniation.
