Using Porcine Cadavers as an Alternative to Human Cadavers for Teaching Minimally Invasive Spinal Fusion: Proof of Concept and Anatomical Comparison.

Training surgeons to perform minimally invasive spinal (MIS) surgery is difficult because there are few realistic alternatives to human cadavers which are expensive and require special handling. In this study we report a protocol for performing an MIS training course on a fresh porcine cadaver. We find that the porcine lumbar spine closely resembles the human spine in terms of the vertebral and discal anatomy. Notable differences include a lower disc height and shallower diameter. We obtained fresh porcine cadavers weighing 40-70 kg from local farmers that had been gutted and bled. We position the cadaver prone on a backboard and set up the operating room with biplanar fluoroscopy. During approach and cage insertion, we found that the tactile feedback obtained is realistic and allows surgeons to familiarize themselves with the procedure. Porcine cadavers were also an excellent tool for practicing pedicle screw fixation due to the larger pedicles. Five training courses involving eight surgeons noted that except for anatomical differences the training course was equivalent to training on human cadavers and unanimously preferred training on porcine cadavers to synthetic foam models. We conclude that porcine cadavers are a useful model for training surgeons in MIS surgery. Routine use of porcine cadavers may increase the availability of MIS surgery training.