Speakers

Spectrum of Simple Discectomy Complications - Dunning Kruger Effect in Microlumbar Discectomy
1109 10:45-10:55
Spine/304A
Introduction- Lumbar microdiscectomy is the bread & butter of most neurosurgeons. The more we do this “supposed to be” simple surgery, the more confident we become. That’s the Dunning Kruger effect taking over. We move across the curve through the various stages from being unconsciously incompetent (when you don’t know what you don’t know), to Consciously incompetent (when you’re aware of what you don’t know and haven’t learned it) to Consciously Competent (when you’re gaining knowledge) to Unconsciously competent (when you’ve mastered something). Materials and Methods – I have looked at the past (latest) 50 surgeries done by me independently. Surgeries done before that have not been included since I would consider myself in the first 3 stages of the Dunning-Kruger curve and the complications experienced would be different. Results – My spectrum of complications include- cerebrospinal leak, post-op ventilation, post-op paresthesia and blade breaking inside the inter-vertebral disc. In one case there was a very thickened nerve root dura mimicking a disc material. One unique complication was the breaking of the No.11 blade into multiple pieces inside the intervertebral disc area. In one surgery, the patient could not be extubated. Another case did not get operated on at the last minute. A regular follow up showed resolution of symptoms and disc dessication and no compression in the latest scans. The benefit of surgery couldn’t be justified and I refrained from operating on that case. Conclusion – Unconscious Competence is the last stage of the Dunning-Kruger effect which emphasizes that you have mastered something. 90% of our work involves less than 10% of our skills and knowledge, so work gets boring. But it is this 90% of our work that affects our practice – one case gone wrong can break the confidence of both sides (the patient and the surgeon).