Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi 39216-4505, USA.
Neurosurgery. 2009 Dec;65(6 Suppl):188-95; discussion 195. doi: 10.1227/01.NEU.0000341534.82210.1B.
Minimally invasive spine surgery (MISS) is among the fastest growing technologies in general neurosurgical practice. In addition, great demand exists to teach these skills to neurosurgery residents. With newly enforced work hour restrictions, opportunities to acquire these skills are limited, necessitating development of alternative strategies of education. We describe a novel simulation model for MISS supplemented by resident self-assessment analysis and evaluation.
The simulator was constructed using a nontransparent Plexiglas frame supplemented with a modified halo frame on which to affix spine specimens. Interchangeable copper tubing was affixed to a 360-degree pivot system to replicate a working portal. Deer skulls and spines were then collected and prepared accordingly. Laboratory exercises were based on the resident's level of training with emphasis on proper drilling techniques. Eight neurosurgery residents were asked to complete the exercises and complete a self-assessment survey regarding their competence level on a scale of 0 to 5, both before and after completing the skill sets. Additionally, they were asked to complete an exit survey that was used to assess the simulation exercises.
All exercises were completed successfully with the exception of placing 2 separate pedicle screws through the same portal, which posed difficulty on some specimens because of the of lack of lordosis of the specimens, leading to unfavorable trajectories using a free-hand technique. With regard to the resident self-assessment analysis, the mean confidence rating for performing an MISS laminectomy improved by a difference of 1.25 points (n = 8; 95% confidence interval, 0.66-1.84; P = 0.0015), from 2.50 to 3.75 before and after simulation exercises, respectively, and reached statistical significance. For the senior-level residents, the mean confidence rating for performing MISS placement of pedicle screws using a free-hand technique improved by a difference of 1.00 (n = 3; 95% confidence interval, -1.48-3.48; P = 0.225), from 3.33 to 4.33 before and after simulation exercises, respectively. Results of the exit survey were encouraging.
The MISS simulator is a feasible, inexpensive, and reproducible adjunct to neurosurgery resident training and provides a new teaching method for spine surgery. Further investigation of this technology is warranted, although multicenter, randomized, controlled trials assessing its validity may not be practical because of ethical constraints with regard to patient safety.
微创脊柱外科 (MISS) 是神经外科实践中发展最快的技术之一。此外，神经外科住院医师对这些技能的教学需求很大。由于新的工作时间限制，获得这些技能的机会有限，因此需要制定替代的教育策略。我们描述了一种新的 MISS 模拟模型，该模型辅以住院医师自我评估分析和评估。
该模拟器使用不透明的有机玻璃框架构建，并辅以可固定脊柱标本的改良 halo 框架。可互换的铜管固定在 360 度枢轴系统上，以模拟工作通道。然后收集并准备鹿头骨和脊柱进行实验室练习。实验室练习基于住院医师的培训水平，重点是适当的钻孔技术。八名神经外科住院医师被要求完成练习，并在完成技能集前后，在 0 到 5 的范围内完成关于他们的能力水平的自我评估调查。此外，他们被要求完成一份出口调查，用于评估模拟练习。
除了通过同一通道放置 2 个单独的椎弓根螺钉外，所有练习都成功完成，因为标本缺乏前凸，因此在某些标本上使用徒手技术会导致不利的轨迹。关于住院医师的自我评估分析，进行 MISS 椎板切除术的平均置信度评分提高了 1.25 分（n = 8；95%置信区间，0.66-1.84；P = 0.0015），分别从模拟练习前后的 2.50 到 3.75，具有统计学意义。对于高级住院医师，使用徒手技术进行 MISS 椎弓根螺钉放置的平均置信度评分提高了 1.00（n = 3；95%置信区间，-1.48-3.48；P = 0.225），分别从模拟练习前后的 3.33 到 4.33，具有统计学意义。出口调查结果令人鼓舞。
MISS 模拟器是神经外科住院医师培训的一种可行、经济且可重复的辅助手段，并为脊柱外科提供了一种新的教学方法。尽管出于患者安全方面的伦理限制，进行多中心、随机、对照试验评估其有效性可能不切实际，但仍需要对此项技术进行进一步研究。
