Simulation with 3D Neuronavigation for Learning Cortical Bone Trajectory Screw Placement

Abstract

Background and Objective Learning a new technique in neurosurgery is a big challenge especially for trainees. In recent years, simulations and simulators got into the focus as a teaching tool. Our objective is to propose a simulator for placement of cortical bone trajectory (CBT) screws to improve results and reduce complications. Methods We have created a platform consisting of a sawbone navigated with a 3D fluoroscope to familiarize our trainees and consultants with CBT technique and later implement it in our department. Objective Structured Assessment of Technical Skills (OSATS) and Physician Performance Diagnostic Inventory Scale (PPDI) were obtained before and after the use of the simulator by the five participants in the study. Patients who were operated on after the implementation of the technique were retrospectively reviewed. Results During the simulation, there were 4 cases of pedicle breach out of 24 screws inserted (16.6%). After having completed simulation, participants demonstrated an improvement in OSATS and PPDI (p = 0.039 and 0.042, respectively). Analyzing the answers to the different items of the tests, participants mainly improved in the knowledge (p = 0.038), the performance (p = 0.041), and understanding of the procedure (p = 0.034). In our retrospective series, eight patients with L4–L5 instability were operated on using CBT, improving their Oswestry Disability Index (ODI) score (preoperative ODI 58.5 [SD 16.7] vs. postoperative ODI 31 [SD 13.4]; p = 0.028). One intraoperative complication due to a dural tear was observed. In the follow-up, we found a case of pseudoarthrosis and a facet joint violation, but no other complications related to misplacement, pedicle fracture, or hardware failure. Conclusion The simulation we have created is useful for the implementation of CBT. In our study, consultants and trainees have valued very positively the learning obtained using the system. Moreover, simulation facilitated the learning of the technique and the understanding of surgical anatomy. We hope that simulation helps reducing complications in the future.

Feasibility and improvement of a three-dimensional printed navigation template for modified cortical bone trajectory screw placement in the lumbar spine

“…Recently, 3D printing techniques have been applied in orthopedic clinics ( 14 , 15 ), showing significant advantages in the treatment of spinal diseases and providing an innovative method to improve accuracy in complex spinal surgical operations ( 16 ). We aimed to explore the safety and veracity of 3D printed navigation templates to assist modified CBT (MCBT) screw placement, as well as investigate the auxiliary operating skill and navigation template performance improvement, so as to provide some fundamental basis for further clinical application.…”

Accuracy and Screw Insertion Time of Robotic-Assisted Cortical Bone Trajectory Screw Placement for Posterior Lumbar Interbody Fusion: A Comparison of Early, Middle, and Late Phases

“…[3]. Due to the difference from the traditional PS trajectory, computer-assisted devices such as navigation [4][5][6][7] and three-dimensional (3D)-printed templates [8][9][10][11] are being used. Furthermore, recently, robotic-assisted spine surgery has been performed, which is expected to contribute to improving the safety of the CBT screw [12][13][14][15][16].…”