Abstract
Purpose
Simulators for pedicle screws placement range from basic sawbones to virtual reality. Yet, they remain expensive and often require specific devices. No free online virtual simulator has yet been developed. The goal was to design a freely accessible Web-based simulator.
Methods
The computer simulator consisted of a lumbar spine, a red box hiding the pedicles and five pairs of screws. After inserting the screws, the red box was removed to assess their position.
A validation study was conducted with 24 medical students randomized into a simulation and a control group. All had a basic course on pedicle screws. The 12 simulation group students performed two sessions on computer. All 24 students then conducted a final common step on sawbones.
The number of misplaced screws, types of breaches, and simulation times were analyzed.
Results
In the final sawbones simulation, 96 real screws were studied. Control group misplaced 50% of their screws compared with only 20.8% in the simulation group (p < 0.05). More careful, simulation group students were slower to insert their real screws.
Over the two computer simulations, the rate of misplaced screws decreased (12.5% vs. 38.3%), showing a good handling of the simulator. Students were able to analyze and correct their pedicle breaches.
Conclusion
This tool is the first free online lumbar pedicle screws simulator. Simulation helped students to better position the final real screws on sawbones. This project showed it was possible to create a free educational tool with no special equipment.
Level of evidence
Level 3.
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Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. The simulator can be accessed on the following website: www.wikispine.org
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by L.C., M.K. and G.R. Primary data analysis was performed by E.F. The first draft of the manuscript was written by L.C., and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Marc Khalifé has shares in Novaspine company. Novaspine company itself has no financial or proprietary interests in any material discussed in this article. The other authors declare that they have no conflict of interest.
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Chatelain, L.S., Khalifé, M., Riouallon, G. et al. Pedagogy in spine surgery: develo** a free and open-access virtual simulator for lumbar pedicle screws placement. Eur Spine J 32, 712–717 (2023). https://doi.org/10.1007/s00586-022-07501-7
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DOI: https://doi.org/10.1007/s00586-022-07501-7