Attitudes regarding barriers to entry and the learning curve associated with endoscopic decompression-only surgery: an international survey.

Abstract

Background context: Endoscopic spine decompression surgery (ESDS) offers numerous benefits, including reduced tissue damage, smaller incisions, shorter recovery times, and a lower risk of complications. However, its adoption among spine surgeons in the United States has been slow. The reluctance to adopt ESDS can be attributed to factors such as the learning curve, cost of equipment and training, and limited access to necessary resources.

Purpose: The primary objective of this study is to assess attitudes toward barriers to and reasons for not adopting ESDS. A secondary objective is to further identify the learning curves, challenges, and common concerns of surgeons considering ESDS adoption.

Study design/setting: An international survey of fellowship-trained spine surgeons from the Society for Minimally Invasive Spine Surgery (SMISS).

Patient sample: A total of 171 fellowship-trained spine surgeons from the Society for Minimally Invasive Spine Surgery voluntarily and anonymously responded to our survey via the RedCap platform. Surgeons were located across the globe, representing six regions.

Outcome measures: Data on current region of practice, specialty training, time in practice, practice type, and surgical volume was obtained for each surgeon who responded to the survey. Additionally, we obtained data on perceived benefits, barriers to entry, and the learning curve of endoscopic techniques.

Methods: A survey was distributed to fellowship-trained spine surgeons from the Society for Minimally Invasive Spine Surgery, with questions focusing on perceived benefits, barriers to adoption, and the learning curve of endoscopic techniques.

Results: A total of 171 surgeons responded to the survey, representing six regions: North America (48.0%), Asia Pacific (28.7%), and Europe (11.7%). Respondents were trained in Orthopaedic Surgery (59.1%) and Neurological Surgery (35.7%). Experience varied, with 35.9% having over 20 years in practice. Most respondents were in Private Practice (59.6%) or Academic/University settings (39.2%), with the majority practicing in urban areas (67.8%). Surgeons were categorized into the EG (50.3%) who used endoscopic techniques and the NEG (49.7%) who did not. There were no significant differences in training types or work settings between the groups. For the NEG, 23.5% were exposed to endoscopic techniques during training, and 50.6% received specific training in practice, mainly through formal industry courses (76.7%). The primary barriers to adopting ESDS were lack of training (55.3%), unavailability of equipment (50.6%), and financial concerns. EG surgeons cited minimizing tissue trauma, improved access to foraminal pathology, and minimizing recovery time as critical factors for using ESDS. Challenges included concerns for incomplete decompression and the duration of surgery, with significant variation in perceived difficulty during the learning curve.

Conclusion: Despite the recognized benefits of ESDS, barriers such as training deficiencies and equipment costs hinder its widespread adoption. Addressing these barriers through enhanced training opportunities and hospital system support could increase the adoption of ESDS, benefiting both surgeons and patients by reducing recovery times and complications.