Complex Spine Pathology Simulator: An Innovative Tool for Advanced Spine Surgery Training

Abstract

Technical advancements in spine surgery have made possible the treatment of increasingly complex pathologies with less morbidity. Time constraints in surgeons' training have made it necessary to develop new training models for spine pathology. To describe the application of a novel compound, Stratathane resin ST-504 derived polymer (SRSDP), that can be injected at different spinal target locations to mimic spinal epidural, subdural extra-axial, and intra-axial pathologies for the use in advanced surgical training. Fresh-frozen thoracolumbar and cervical spine segments of human and sheep cadavers were used to study the model. SRSDP is initially liquid after mixing, allowing it to be injected into target areas where it expands and solidifies, mimicking the entire spectrum of spinal pathologies. Different polymer concentrations have been codified to vary adhesiveness, texture, spread capability, deformability, and radiologic visibility. Polymer injection was performed under fluoroscopic guidance through pathology-specific injection sites that avoided compromising the surgical approach for subsequent excision of the artificial lesion. Inflation of a balloon catheter of the desired size was used to displace stiff cadaveric neurovascular structures to mimic pathology-related mass effect. The traditional cadaveric training models principally only allow surgeons to practice the surgical approach. The complex spine pathology simulator is a novel educational tool that in a user-friendly, low-cost fashion allows trainees to practice advanced technical skills in the removal of complex spine pathology, potentially shortening some of the aspects of the learning curve of operative skills that may otherwise take many years to acquire.

Metrics Development for Minimal Invasive Unilateral Laminotomy for Bilateral Decompression of Lumbar Spinal Stenosis With and Without Spondylolisthesis by an International Expert Panel

“…The systematic implementation of a simulation curriculum in neurosurgery or orthopedic training programs has been proven to be feasible, is favorably regarded, and has a positive impact on trainees of all levels. 8 Therefore, a few academic centers around the world have focused on the role of highly realistic spine surgery simulation models to train spine surgeons [9][10][11][12][13][14] and even though simulation training is not a substitute for operating room experience, it may decrease the time teaching intraoperatively and reduce the morbidity secondary to resident surgical errors.…”

Neurosurgical cadaveric and in vivo large animal training models for cranial and spinal approaches and techniques — a systematic review of the current literature

“…Dissection of cadaveric sheep head www.journals.viamedica.pl/neurologia_neurochirurgia_polska Cezar Octavian Morosanu et al, Neurosurgical cadaveric and in vivo large animal training models for cranialGragnaniello et al[25] who in 2016 described a fluoroscopic injection with Stratathane resin ST-504 into an ovine spine, thus creating a similar spinal lesion.…”

Emerging Technologies within Spine Surgery

“…Consequently, researchers are working to improve synthetic tissue biomechanical characteristics. For instance, Gragnaniello et al developed a polymer that can be injected into animal or human cadaveric models in order to mimic spinal pathology [142]. Mixed reviews exist regarding perceptions of bioskills training efficacy.…”