Simulation on synthetic bone : A tool for teaching thoracolumbar pedicle screw placement
Copyright © 2021 Elsevier Masson SAS. All rights reserved..
INTRODUCTION: Simulation workshops for surgical training of residents are becoming popular. The gold standard for teaching thoracolumbar pedicle screw placement are cadaver labs; however, the availability of human bodies is limited. The primary objective of this study was to determine if training on a synthetic bone model improves the apprenticeship of accurate pedicle screw placement. The secondary objective was to check the influence of residents' previous experience in spine surgery.
HYPOTHESIS: The main hypothesis was that theoretical learning with practical application on synthetic bone was superior to theoretical learning alone.
METHODS: Twenty-three orthopedic residents were taught about free-hand pedicle screw placement using a theoretical presentation. Six residents had previous experience with screwing techniques. After randomization in two groups, 11 residents (group 1) participated in a workshop on synthetic bone, whereas 12 residents received only theoretical instruction (group 2). Each resident was asked to place two thoracic screws (T7-T11) and two lumbar screws (L1-L5) on a cadaver. Screw placement accuracy was analyzed using the Gertzbein classification on computed tomography (grades 0 and 1=accurate positioning; grades 2 and 3=malposition>2mm).
RESULTS: Rates of accurate screw positioning were 64.0% and 62.5% for thoracic levels, and 72.7% and 66.6% for lumbar levels in group 1 and 2, respectively. There was no significant difference in malposition rates on cadavers between the groups (p=0.1809). A resident who was first trained by simulation had a chance of decreasing the Gertzbein score with an odds-ratio of 1.7714 [0.7710-4.1515]. The odds ratio was 4.5188 [0.0456-0.8451] when comparing residents with previous experience in spinal surgery to novice residents.
DISCUSSION: Theoretical teaching associated with a simulation model is relevant for learning a surgical technique. A single simulation workshop on synthetic bone seems insufficient to improve pedicle screw placement accuracy compared to theoretical teaching alone. Progressive experience and the repetition of technical gestures during hands-on supervised learning in spine surgery with a senior surgeon had an influence on the accuracy of pedicle screw placement.
LEVEL OF EVIDENCE: II.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:107 |
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| Enthalten in: |
Orthopaedics & traumatology, surgery & research : OTSR - 107(2021), 8 vom: 30. Dez., Seite 103056 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Saur, Maurise [VerfasserIn] |
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| Links: |
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| Themen: |
Journal Article |
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| Anmerkungen: |
Date Completed 10.03.2022 Date Revised 11.03.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.otsr.2021.103056 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM330785230 |
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| 245 | 1 | 0 | |a Simulation on synthetic bone |b A tool for teaching thoracolumbar pedicle screw placement |
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| 500 | |a Date Revised 11.03.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 Elsevier Masson SAS. All rights reserved. | ||
| 520 | |a INTRODUCTION: Simulation workshops for surgical training of residents are becoming popular. The gold standard for teaching thoracolumbar pedicle screw placement are cadaver labs; however, the availability of human bodies is limited. The primary objective of this study was to determine if training on a synthetic bone model improves the apprenticeship of accurate pedicle screw placement. The secondary objective was to check the influence of residents' previous experience in spine surgery | ||
| 520 | |a HYPOTHESIS: The main hypothesis was that theoretical learning with practical application on synthetic bone was superior to theoretical learning alone | ||
| 520 | |a METHODS: Twenty-three orthopedic residents were taught about free-hand pedicle screw placement using a theoretical presentation. Six residents had previous experience with screwing techniques. After randomization in two groups, 11 residents (group 1) participated in a workshop on synthetic bone, whereas 12 residents received only theoretical instruction (group 2). Each resident was asked to place two thoracic screws (T7-T11) and two lumbar screws (L1-L5) on a cadaver. Screw placement accuracy was analyzed using the Gertzbein classification on computed tomography (grades 0 and 1=accurate positioning; grades 2 and 3=malposition>2mm) | ||
| 520 | |a RESULTS: Rates of accurate screw positioning were 64.0% and 62.5% for thoracic levels, and 72.7% and 66.6% for lumbar levels in group 1 and 2, respectively. There was no significant difference in malposition rates on cadavers between the groups (p=0.1809). A resident who was first trained by simulation had a chance of decreasing the Gertzbein score with an odds-ratio of 1.7714 [0.7710-4.1515]. The odds ratio was 4.5188 [0.0456-0.8451] when comparing residents with previous experience in spinal surgery to novice residents | ||
| 520 | |a DISCUSSION: Theoretical teaching associated with a simulation model is relevant for learning a surgical technique. A single simulation workshop on synthetic bone seems insufficient to improve pedicle screw placement accuracy compared to theoretical teaching alone. Progressive experience and the repetition of technical gestures during hands-on supervised learning in spine surgery with a senior surgeon had an influence on the accuracy of pedicle screw placement | ||
| 520 | |a LEVEL OF EVIDENCE: II | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Pedicle screw placement | |
| 650 | 4 | |a Simulation | |
| 650 | 4 | |a Surgical pedagogy | |
| 650 | 4 | |a Synthetic bone | |
| 650 | 4 | |a Thoracolumbar spine model | |
| 700 | 1 | |a Guillard, Benjamin |e verfasserin |4 aut | |
| 700 | 1 | |a Collinet, Arnaud |e verfasserin |4 aut | |
| 700 | 1 | |a Schmitz, Arthur |e verfasserin |4 aut | |
| 700 | 1 | |a Sauleau, Erik André |e verfasserin |4 aut | |
| 700 | 1 | |a Clavert, Philippe |e verfasserin |4 aut | |
| 700 | 1 | |a Koch, Guillaume |e verfasserin |4 aut | |
| 700 | 1 | |a Vidailhet, Pierre |e verfasserin |4 aut | |
| 700 | 1 | |a Gasia, Victor |e verfasserin |4 aut | |
| 700 | 1 | |a Charles, Yann Philippe |e verfasserin |4 aut | |
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