Object Simulation has become an important tool in neurosurgical education as part of the complex process of improving residents' technical expertise while preserving patient safety. Although different simulators have already been designed for a variety of neurosurgical procedures, spine simulators are still in their infancy and, at present, there is no available simulator for lumbar spine pathologies in pediatric neurosurgery. In this paper the authors describe the peculiarities and challenges involved in developing a synthetic simulator for pediatric lumbar spine pathologies, including tethered spinal cord syndrome and open neural tube defects. Methods The Department of Neurosurgery of the University of Illinois at Peoria, in a joint program with the Mechanical Engineering Department of Bradley University, designed and developed a general synthetic model for simulating pediatric neurosurgical interventions on the lumbar spine. The model was designed to be composed of several sequential layers, so that each layer might closely mimic the tensile properties of the natural tissues under simulation. Additionally, a system for pressure monitoring was developed to enable precise measurements of the degree of manipulation of the spinal cord. Results The designed prototype successfully simulated several scenarios commonly found in pediatric neurosurgery, such as tethered spinal cord, retethered spinal cord, and fatty terminal filum, as well as meningocele, myelomeningocele, and lipomyelomeningocele. Additionally, the formulated grading system was able to account for several variables involved in the qualitative evaluation of the technical performance during the training sessions and, in association with an expert qualitative analysis of the recorded sessions, proved to be a useful feedback tool for the trainees. Conclusions Designing and building a synthetic simulator for pediatric lumbar spine pathologies poses a wide variety of unique challenges. According to the authors' experience, a modular system composed of separable layers that can be independently replaced significantly enhances the applicability of such a model, enabling its individualization to distinctive but interrelated pathologies. Moreover, the design of a system for pressure monitoring (as well as a general score that may be able to account for the overall technical quality of the trainee's performance) may further enhance the educational applications of a simulator of this kind so that it can be further incorporated into the neurosurgical residency curriculum for training and evaluation purposes.

The trend in provider ordering rates of DXA scans did not decrease after the release of the DXA Choosing Wisely recommendation. Targeted initiatives addressing providers with high ordering rates will be needed to change behavior.

Medical simulation is a developing field used in the education of medical students, doctors, residents, and many other medical professionals. Despite emerging simulation tools, little has been done to address surgeries in congenital patients, specifically with regards to the spinal cord. The objective of this project was to design, fabricate, and functionally evaluate a medical simulator to address the challenge of teaching the spinal detethering surgical procedure to neurosurgery residents. This simulator was designed to mimic anatomical and physiological characteristics of the lower lumbar region. Pressure sensors were used to quantify the forces that were applied to the spinal cord during the surgical procedure and a LabVIEW program was developed to monitor the pressure profile. The simulator was functionally evaluated by six residents, one fellow, one doctor, and two medical students. A conclusive, quantitative method for scoring these surgeries has not yet been developed, however, the residents and medical students were able to compare their procedures with those of more experienced doctors and fellows via qualitative methods. Future developments will include incorporating quantitative scoring methods as well as noise elimination hardware into the design.