Division of Neurosurgery University Hospital 12 de Octubre, Madrid, Spain.
Division of Neurosurgery, University Hospital La Princesa, Madrid, Spain.
J Neurol Surg A Cent Eur Neurosurg. 2021 May;82(3):262-269. doi: 10.1055/s-0040-1715485. Epub 2020 Dec 1.
Learning a new technique in neurosurgery is a big challenge especially for trainees. In recent years, simulations and simulators got into the focus as a teaching tool. Our objective is to propose a simulator for placement of cortical bone trajectory (CBT) screws to improve results and reduce complications.
We have created a platform consisting of a sawbone navigated with a 3D fluoroscope to familiarize our trainees and consultants with CBT technique and later implement it in our department. Objective Structured Assessment of Technical Skills (OSATS) and Physician Performance Diagnostic Inventory Scale (PPDI) were obtained before and after the use of the simulator by the five participants in the study. Patients who were operated on after the implementation of the technique were retrospectively reviewed.
During the simulation, there were 4 cases of pedicle breach out of 24 screws inserted (16.6%). After having completed simulation, participants demonstrated an improvement in OSATS and PPDI ( = 0.039 and 0.042, respectively). Analyzing the answers to the different items of the tests, participants mainly improved in the knowledge ( = 0.038), the performance ( = 0.041), and understanding of the procedure ( = 0.034). In our retrospective series, eight patients with L4-L5 instability were operated on using CBT, improving their Oswestry Disability Index (ODI) score (preoperative ODI 58.5 [SD 16.7] vs. postoperative ODI 31 [SD 13.4]; = 0.028). One intraoperative complication due to a dural tear was observed. In the follow-up, we found a case of pseudoarthrosis and a facet joint violation, but no other complications related to misplacement, pedicle fracture, or hardware failure.
The simulation we have created is useful for the implementation of CBT. In our study, consultants and trainees have valued very positively the learning obtained using the system. Moreover, simulation facilitated the learning of the technique and the understanding of surgical anatomy. We hope that simulation helps reducing complications in the future.
学习神经外科新技术对学员来说是一个巨大的挑战。近年来，模拟训练和模拟器已成为教学工具的焦点。我们的目标是提出一种皮质骨轨迹（CBT）螺钉放置模拟器，以提高手术效果，减少并发症。
我们创建了一个平台，该平台由导航锯骨和 3D 透视仪组成，用于使我们的学员和顾问熟悉 CBT 技术，然后在我们的部门实施该技术。在使用模拟器之前和之后，对研究中的五名参与者进行了客观结构化评估技术技能（OSATS）和医师表现诊断量表（PPDI）评估。回顾性分析了在该技术实施后接受手术的患者。
在模拟过程中，24 颗螺钉中有 4 颗（16.6%）穿出椎弓根。参与者完成模拟后，OSATS 和 PPDI 均有所提高（ = 0.039 和 0.042）。分析测试中不同项目的答案，参与者在知识（ = 0.038）、表现（ = 0.041）和对手术过程的理解（ = 0.034）方面有了明显提高。在我们的回顾性研究中，对 8 例 L4-L5 不稳定的患者进行了 CBT 手术，他们的 Oswestry 功能障碍指数（ODI）评分有所改善（术前 ODI 为 58.5[16.7]比术后 ODI 为 31[13.4]； = 0.028）。术中观察到一例硬脊膜撕裂导致的并发症。随访时，我们发现 1 例假关节形成和 1 例关节突关节侵犯，但没有其他与螺钉位置不当、椎弓根骨折或内固定失败相关的并发症。
我们创建的模拟器对于 CBT 的实施很有用。在我们的研究中，顾问和学员都非常肯定使用该系统获得的学习效果。此外，模拟有助于学习技术和理解手术解剖结构。我们希望模拟能够帮助减少未来的并发症。
