Simulation on synthetic bone: A tool for teaching thoracolumbar pedicle screw placement.
Orthop Traumatol Surg Res
; 107(8): 103056, 2021 12.
Article
em En
| MEDLINE
| ID: mdl-34536595
ABSTRACT
INTRODUCTION:
Simulation workshops for surgical training of residents are becoming popular. The gold standard for teaching thoracolumbar pedicle screw placement are cadaver labs; however, the availability of human bodies is limited. The primary objective of this study was to determine if training on a synthetic bone model improves the apprenticeship of accurate pedicle screw placement. The secondary objective was to check the influence of residents' previous experience in spine surgery.HYPOTHESIS:
The main hypothesis was that theoretical learning with practical application on synthetic bone was superior to theoretical learning alone.METHODS:
Twenty-three orthopedic residents were taught about free-hand pedicle screw placement using a theoretical presentation. Six residents had previous experience with screwing techniques. After randomization in two groups, 11 residents (group 1) participated in a workshop on synthetic bone, whereas 12 residents received only theoretical instruction (group 2). Each resident was asked to place two thoracic screws (T7-T11) and two lumbar screws (L1-L5) on a cadaver. Screw placement accuracy was analyzed using the Gertzbein classification on computed tomography (grades 0 and 1=accurate positioning; grades 2 and 3=malposition>2mm).RESULTS:
Rates of accurate screw positioning were 64.0% and 62.5% for thoracic levels, and 72.7% and 66.6% for lumbar levels in group 1 and 2, respectively. There was no significant difference in malposition rates on cadavers between the groups (p=0.1809). A resident who was first trained by simulation had a chance of decreasing the Gertzbein score with an odds-ratio of 1.7714 [0.7710-4.1515]. The odds ratio was 4.5188 [0.0456-0.8451] when comparing residents with previous experience in spinal surgery to novice residents.DISCUSSION:
Theoretical teaching associated with a simulation model is relevant for learning a surgical technique. A single simulation workshop on synthetic bone seems insufficient to improve pedicle screw placement accuracy compared to theoretical teaching alone. Progressive experience and the repetition of technical gestures during hands-on supervised learning in spine surgery with a senior surgeon had an influence on the accuracy of pedicle screw placement. LEVEL OF EVIDENCE II.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Ortopedia
/
Fusão Vertebral
/
Cirurgia Assistida por Computador
/
Parafusos Pediculares
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article