Spinal Navigation during Orthopedic Residency Training: A Double-Edged Sword?

Abstract

Background Orthopedic residents in our institute have the opportunity to participate in navigation-assisted spine surgery during their residency training. This paves the way for a new dimension of learning spine surgery, which the previous generation was not exposed to. To study this in detail, we conducted a cross-sectional descriptive survey among our residents to analyse their perception, understanding, and competency regarding pedicle screw application using spinal navigation. Methods We selected orthopedic residents (n = 20) who had completed 3 years of training that included at least one rotation (4–6 months) in our spine division. They were asked to respond to a four-part questionnaire that included general and Likert scale-based questions. The first two parts dealt with various parameters regarding spinal navigation and free-hand technique for applying pedicle screws. The third part dealt with residents' opinion regarding the advantages and disadvantages of spinal navigation. The final part was an objective analysis of residents' ability to identify the pedicle screw entry points in selected segments. Results We found that our residents were better trained to apply pedicle screws using spinal navigation. The mean Likert scale score for perception regarding their competency to apply pedicle screws using spinal navigation was 3.65 ± 0.81, compared to only 2.8 ± 0.77 when using the free-hand technique. All residents agreed that spinal navigation is an excellent teaching tool with higher accuracy and greater utility in anatomically critical cases. However, 35% of the residents were not able to identify the entry points correctly in the given segments. Conclusions All selected residents were perceived to be competent to apply pedicle screws using spinal navigation. However, some of them were not able to identify the entry points correctly, probably due to overreliance on spinal navigation. Therefore, we encourage residents to concentrate on surface anatomy and tactile feedback rather than completely relying on the navigation display monitor during every screw placement. In addition, incorporating cadaveric and saw bone workshops as a part of teaching program can enhance better understanding of surgical anatomy.

Longitudinal Assessment of Modern Spine Surgery Training

“…Neurological surgeons used significantly more cases with navigation and had a trend toward using more robotic surgery, compared with orthopaedic surgeons. This finding of increased navigation and robotic surgery in neurological surgery is one that has been demonstrated in prior studies 16 , although the utility of technology in spine training has been brought up as a "doubleedged sword" because of the relative lack of experience with more traditional methods of screw placement 17 .…”

Accuracy of Thoracolumbar Pedicle Screw Insertion Based on Routine Use of Intraoperative Imaging and Navigation

“…In addition to the numerous benefits of navigation, we found it to be a good teaching tool in a recent study performed at our institution [ 29 ]. It allows surgeons in training to correlate the surface anatomy to the internal bony anatomy.…”

A Clinical Application Study of Mixed Reality Technology Assisted Lumbar Pedicle Screws Implantation

“…Due to its obvious advantages, and ability to overcome shortcomings of traditional model surgery, MR technology shows a wide range of potential applications. The development of MR technology can better promote the growth of new, young spine surgeons if they can visually view the location of lesions from multiple angles during operation and conduct virtual operation by rebuilding the 3D structure of the spine [ 32 , 33 ]. At the same time, it is hoped that a tracker can be installed on the patient during the operation for real-time follow-up, so as to reduce the influence of pathological changes at the site of the operation [ 34 ].…”