Abstract
Background and Objective 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.
Methods 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.
Results 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 (p = 0.039 and 0.042, respectively). Analyzing the answers to the different items of
the tests, participants mainly improved in the knowledge (p = 0.038), the performance (p = 0.041), and understanding of the procedure (p = 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]; p = 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.
Conclusion 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.
Keywords
cortical bone trajectory - simulation - neurosurgical training - complications.
