Introduction: The authors explored the ability of a virtual reality haptic-based spine simulator to improve screw placement accuracy in sawbone models by neurosurgery applicants receiving a single training session.
Methods: We used the ImmersiveTouch® (ImmersiveTouch, Inc., Chicago, IL) simulator. Thirty eight consecutive applicants to neurosurgery residency were offered anonymous participation in the study, and randomized into 3 groups prior to the placement of two lumbar pedicle screws in a sawbone model: (A) Control – no prior simulation; (B) Simulation of pedicle finder insertion in a 3-D vertebra; and (C) Lumbar pedicle screw insertion within a surgical environment. The sawbone models then underwent CT imaging and triplanar analysis to detect errors in screw coronal entry point, axial and sagittal deviations, length error, and pedicle breach. The screw placement was further classified into acceptable (= 2 errors) or not acceptable (= 3 errors) based on the above variables. The overall performance in each group was based on the mean number of errors per screw. Semiparametric regression analysis for clustered data was used to detect group differences.
Results: A total of 38 students with 76 pedicle screws were analyzed. Group B (pedicle finder simulation), improved performance by 23.8% (p=0.1458) vs. group A (no simulation); Group C (open pedicle screw simulation) improved by 53.7% (p = 0.0067) vs. group A and 39.3% (p = 0.0754) vs. group B. Reductions in the number of unacceptable screws was 17.9% and 26.9% for groups B and C respectively relative to group A.
Conclusions: Computer-simulation training positively impacts the accuracy of pedicle screw placement performed by neurosurgery applicants in sawbone models, with only a single simulated practice, compared to individuals with no prior simulation exposure.
Patient Care: Simulated immersion in a realistic surgical experience may lead to a greater effect in the physical world. Incorporating this technology into training may prove beneficial by improving accuracy of the screw placement which is critical to reduction of neurogenic pain and related complications.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of computer simulation and its impact on surgical technical performance in the real world, 2) Discuss, in small groups, the use of simulation as a educational tool and how it can complement the conventional teaching methodology.