Division of Spine, Department of Orthopedic Surgery, Tan Tock Seng Hospital, Singapore.
Department of Orthopedic Surgery, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Tamil Nadu, India.
Clin Orthop Surg. 2019 Jun;11(2):170-175. doi: 10.4055/cios.2019.11.2.170. Epub 2019 May 9.
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.
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.
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.
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.
我院骨科住院医师在住院医师培训期间有机会参与导航辅助脊柱手术。这为学习脊柱手术开辟了一个新的维度，而前几代人并没有接触过这个领域。为了详细研究这一点，我们对住院医师进行了一项横断面描述性调查，以分析他们在脊柱导航下应用椎弓根螺钉时的感知、理解和能力。
我们选择了已经完成了 3 年培训的骨科住院医师（n=20），其中包括我们脊柱科至少一个轮转（4-6 个月）。他们被要求回答一个四部分的问卷，包括一般问题和李克特量表问题。前两部分涉及脊柱导航和徒手技术应用椎弓根螺钉的各种参数。第三部分涉及住院医师对脊柱导航优缺点的看法。最后一部分是对住院医师在选定节段识别椎弓根螺钉进钉点能力的客观分析。
我们发现，我们的住院医师在使用脊柱导航应用椎弓根螺钉方面接受了更好的培训。他们使用脊柱导航应用椎弓根螺钉的能力感知的平均李克特量表评分为 3.65±0.81，而使用徒手技术时仅为 2.8±0.77。所有住院医师都认为脊柱导航是一种极好的教学工具，在解剖学上关键病例中具有更高的准确性和更大的实用性。然而，35%的住院医师在给定的节段无法正确识别进钉点。
所有选定的住院医师都被认为能够使用脊柱导航应用椎弓根螺钉。然而，他们中的一些人无法正确识别进钉点，可能是因为过于依赖脊柱导航。因此，我们鼓励住院医师在每次放置螺钉时，专注于表面解剖和触觉反馈，而不是完全依赖导航显示器。此外，将尸体和锯骨工作坊纳入教学计划的一部分，可以增强对手术解剖学的更好理解。
