Significance of Preoperative Planning Simulator for Junior Surgeons’ Training of Pedicle Screw Insertion

Study Design: A prospective study to access the significance of preoperative planning simulator for junior surgeons’ training of pedicle screw insertion. Summary of Background Data: Pedicle screw insertion is particularly challenging to carry out on patients with abnormal spine morphology, especially for the doctors who lack experience. Currently, preoperative planning for pedicle screw insertion is carried out using patient computed tomography and magnetic resonance imaging scans. In addition, there is no projection fluoroscopy provided to the user. Objective: The aim of this study was to investigate the feasibility and efficacy of a 3-dimensional, patient-specific volume rendering combined with the projection fluoroscopy simulator for training junior surgeons with no experience of pedicle screw insertion, and to help identify the role such simulation has in surgical education. Methods: Two junior surgeons with no experience of pedicle screw insertion were trained on the technique through the preoperative planning simulator; the operative time and the position of the pedicle screws were assessed before training (control group 1) and after training (experimental group) and compared with 2 senior spine surgeons with >10 years’ experience of pedicle screw insertion (control group 2). Results: The time of per pedicle screw insertion was 43.5±3.9 seconds in control group 1, 31.6±2.9 seconds in control group 2, and 50.8±3.7 seconds in experimental group. The relative position of the screw to the pedicle was graded regarding pedicle breach (I, no breach; II, <2 mm; III, 2–4 mm; IV, >4 mm). The pedicle breach grading I and II was 20 pedicle screws (20/56, 35.7%) in control group 1, 54 pedicle screws (54/56, 96.4%) in control group 2, and 44 pedicle screws (44/56, 78.6%) in the experimental group. There were significant differences between control group 1 and experimental group in the time of per pedicle screw insertion (P<0.001) and the rate of pedicle breach grading I and II (P<0.001). There were significant differences between control group 2 and experimental group in the time of per pedicle screw insertion (P<0.001) and the rate of pedicle breach grading I and II (P=0.004). Conclusions: The simulator offers many helpful features to the surgeon with respect to the surgical trainee learning the basic technique of pedicle screw insertion, using free-hand technique or under the guiding of intraoperative fluoroscopy. The surgical skills of the junior surgeons can be significantly improved through the training of simulator.