The use of computer-assisted surgery as an educational tool for the training of orthopedic surgery residents in pedicle screw placement: a pilot study and survey among orthopedic residents

Abstract

Background:The training of orthopedic residents in adequate pedicle screw placement is very important. We sought to investigate orthopedic residents' perspectives on the use of computer-assisted surgery (CAS) in a training trial. Methods:Orthopedic residents were randomly assigned to independently place a screw using the free-hand technique and the CAS technique on 1 of 3 cadavers (Cobb angles 5º, 15º and 67º) at randomly selected thoracolumbar vertebral levels. All residents were blinded to their colleagues' pedicle screw placements and were asked to complete a short questionnaire at the end of the session to evaluate their experience with CAS. We obtained CT images for each cadaver to assess pedicle screw placement accuracy and classified placement as A) screw completely in pedicle, B) screw < 2 mm outside pedicle, C) screw 2-4 mm outside pedicle, or D) screw > 4 mm outside pedicle.Results: Twenty-four orthopedic residents participated in this trial study. In total, 65% preferred using the free-hand technique in an educational setting even though most (60%) said that CAS is safer. The main reason for free-hand technique preference was the difficult technical aspects encountered with CAS. In addition, accuracy of pedicle screw placement in this trial showed that 5 screws were classified as A or B (safe zone) and 19 as grade C or D (unsafe zone) using the free-hand technique compared with 15 and 9, respectively, using CAS (p = 0.008). Conclusion:Orthopedic residents perceived CAS as safe and demonstrated improved accuracy in pedicle screw placement in a single setting. However, the residents preferred the free-hand technique in an educational stetting owing to the difficult technical aspects of CAS.Contexte : Il est très important d'apprendre aux médecins résidents en chirurgie orthopédique comment positionner adéquatement une vis pédiculaire. Notre objectif était d'obtenir l'opinion des médecins résidents sur le recours à la chirurgie assistée par ordinateur (CAO) dans un essai sur la formation. Méthodes :Des médecins résidents en chirurgie orthopédique répartis aléatoire-ment ont placé indépendamment une vis à l'aide d'une technique à main libre basée sur les repères topographiques et la palpation, et de la CAO dans 1 de 3 cadavres (angles de Cobb de 5°, 15° et 67°) dans une vertèbre dorsolombaire sélectionnée aléatoirement. Aucun des médecins résidents n'a pu observer le positionnement de la vis de ses collègues, et les participants ont rempli un court questionnaire à la fin de la séance pour évaluer leur expérience de la CAO. Nous avons obtenu un tomodensitogramme pour chaque cadavre afin d'évaluer la précision du positionnement de la vis pédiculaire, classée selon 4 catégories : A) vis entièrement dans le pédicule, B) vis < 2 mm hors du pédicule, C) vis de 2-4 mm hors du pédicule, ou D) vis > 4 mm hors du pédicule.Résultats : Vingt-quatre médecins résidents en chirurgie orthopédique ont participé à l'étude clinique. Au total, 65 % d'entre eux ont préféré utiliser la technique à main libre dans un contexte d...

The effect of simulation training on resident proficiency in thoracolumbar pedicle screw placement using computer-assisted navigation

“…5 However, residents rate unfamiliarity with 3D navigation as a major impediment to its usage. 6 An ideal resident training module to improve safe and efficient pedicle screw placement would increase a resident's experience with placing ABBREVIATIONS GEE = generalized estimating equation; OSATS = Objective Structured…”

Teaching Training and Surgical Education in Minimally Invasive Surgery (MIS) of the Spine: What Are the Best Teaching and Learning Strategies for MIS? Do We Have Any Experience and Data?

“…This technology enables a real time interaction with the creation of graphics and adds difficulties according to the level of training of each particular surgeon. 7,13…”

“…This technology enables a real time interaction with the creation of graphics and adds difficulties according to the level of training of each particular surgeon. 7,13 Barriers for Teaching Training in MISS Each learning method involves particular limitations. The limitation in cadaveric or animal training includes the ethical aspects, the need for an approved structure according to the practice itself, the biological risks and the high cost.…”

Detection of Common Anatomical Landmarks and Vertical Trajectories for Freehand Pedicle Screw Placement

“…7,[12][13][14][15] Since surgical experience is closely related to the accuracy of freehand screw placement, advanced surgeons prefer to use classical freehand techniques to achieve good results. [16][17][18] This study aimed to: (i) propose a common anatomical point and trajectory; (ii) compare the differences between different modalities of manual technique; and (iii) compare physicians with different clinical experiences to determine the accuracy of this manual technique.…”