Cadaver Training Module for Teaching Thoracic Pedicle Screw Placement to Residents

Abstract

Surgical training using simulators has been shown to be highly effective but is not available for some applications and is too expensive for many programs. The authors piloted a cadaver-based module with the goal of objectively measuring and significantly improving orthopedic residents' surgical skills in placing thoracic pedicle screws, an advanced procedure. An experienced spine surgeon placed thoracic pedicle screws in 7 cadavers (T1-T12) to establish the skilled accuracy rate. For this pilot study, 3 orthopedic residents unfamiliar with the procedure were given didactic training for safe thoracic pedicle screw insertion. Each resident instrumented alternating sides of 5 consecutive cadavers (T1-T12). Screw positions were graded by computed tomography in a blinded fashion, with accuracy defined as no shank breach of the pedicle or vertebral body. Results were reviewed with the residents, instruction was repeated, and alternating sides of 5 cadavers were instrumented by the residents. The experienced surgeon accurately placed 67 (82%) of 82 pedicle screws. Residents accurately placed 80 (44%) of 180 pedicle screws in the initial set of specimens and 105 (58%) of 180 pedicle screws in the second set of specimens (P=.01). Accuracy varied significantly among residents before but not after computed tomography review. The study's results show that a cadaver-based training module that resembles the clinical setting can be used to teach complex surgical skills to orthopedic residents.

Virtual reality spine surgery simulation: an empirical study of its usefulness

“…[10][11][12] Human cadaver models are also used for practicing both intracranial and spinal surgical techniques. 13 Although these models provide good anatomical detail, limitations include inability to replicate the various neurosurgical pathologies and to reproduce the behavior of living tissue. As a result, alternative training apparatuses have been sought and several studies have explored the use of either synthetic physical or computer-based models for learning neurosurgical spine procedures involving both open and minimally invasive pedicle screw placement and cervical laminectomy or foraminotomy.…”

A pilot study of the utility of a laboratory-based spinal fixation training program for neurosurgical residents

“…9,14 A number of recent studies have attempted to compare the benefits of various laboratorybased techniques, although most do not demonstrate significant benefit. 7,9,14 To date, a definitive, evidence-based, laboratory training module has not been delineated.…”

Systematic review of the current status of cadaveric simulation for surgical training

“…Fifty‐one studies were included in the review, of which 47 were full‐text original research articles and four were conference posters. The main characteristics of studies, including OCEBM and mean MERSQI scores are shown in Tables S2 – S5 (supporting information).…”

“…Various score‐based methods were also used, including procedure scores, global rating scale (GRS), OSATS (Objective Structured Assessment of Technical Skills in Surgery) and the GOALS (Global Operative Assessment of Laparoscopic Skills) scale. Seven of the 23 studies were RCTs and 16 were cohort studies. Of the seven RCTs, three compared cadaveric simulation with no simulation training, and four compared cadaveric simulation with low‐fidelity simulation.…”