Introduction: Spinal instrumentation placement is a standard competency in neurosurgery and orthopedic surgery residency. There is no existing standard for the safest, most efficient method of training. Cadaveric labs have highest learner rating of utility but highest cost/anatomic variability and lowest availability. Virtual simulator skills have not translated to actual manual performance. However, usage of synthetic, anatomically accurate models for spinal instrumentation placement has shown significant benefit to learners’ subjective and objective proficiency. Computer-assisted navigation further improves screw accuracy and reduces surgeon radiation exposure but is rated as difficult to use by learners. Our objective was to evaluate the effect of a standardized, reproducible curriculum on subjective and objective performance by resident trainees in placing spinal instrumentation using computer-assisted navigation on a synthetic spine model.
Methods: Fifteen neurosurgery and orthopedic surgery residents participated in a standardized curriculum with lecture followed by two separate sessions of thoracolumbar pedicle screw placement in a synthetic model utilizing three-dimensional computer-assisted navigation. Data was collected on pre-module experience, time and accuracy of screw placement, and both subjective and objective rating of proficiency.
Results: Fifteen of fifteen residents demonstrated improvement in subjective (PPDIS) and objective (OSATS) measures of proficiency in navigated screw placement with utilization of this curriculum (p<0.001 for both) regardless of the number of cases of previous experience using thoracolumbar spinal instrumentation. Fourteen of fifteen residents demonstrated decreased time per screw placement from session 1 to session 2 (p=0.006). There was no significant difference in pedicle screw accuracy between session 1 and session 2.
Conclusions: A standardized curriculum using synthetic simulator training for navigated thoracolumbar pedicle screw placement results in significantly improved resident subjective and objective proficiency. Development of a nationwide competency curriculum using simulation training for spinal instrumentation placement should be considered for safe, efficient resident training.
Patient Care: We developed a novel, reproducible, efficient standardized resident training module for placement of thoracolumbar pedicle screws in a synthetic spine model utilizing computer-assisted navigation that resulted in significantly improved resident subjective and objective proficiency. This has broad applicability to improve efficiency and safety of resident training, translating into direct patient benefit via increased proficiency of resident trainees.
Learning Objectives: By the conclusion of this session, participants should be able to:
1. Describe advantages and disadvantages of ex vivo training methods for spinal instrumentation placement.
2. Discuss costs/benefits of using computer-assisted navigation in spinal instrumentation placement.
3. Identify the effect of a standardized curriculum on residents’ subjective and objective performance in placing spinal instrumentation.