title: Significance of preoperative planning simulator for junior surgeons' training of pedicle screw insertion.
abstract: METHODS
  A prospective study to access the significance of preoperative planning simulator for junior surgeons' training of pedicle screw insertion.
  
  
  BACKGROUND
  Pedicle screw insertion is particularly challenging to carry out on patients with abnormal spine morphology, especially for the doctors who lack experience. Currently, preoperative planning for pedicle screw insertion is carried out using patient computed tomography and magnetic resonance imaging scans. In addition, there is no projection fluoroscopy provided to the user.
  
  
  OBJECTIVE
  The aim of this study was to investigate the feasibility and efficacy of a 3-dimensional, patient-specific volume rendering combined with the projection fluoroscopy simulator for training junior surgeons with no experience of pedicle screw insertion, and to help identify the role such simulation has in surgical education.
  
  
  METHODS
  Two junior surgeons with no experience of pedicle screw insertion were trained on the technique through the preoperative planning simulator; the operative time and the position of the pedicle screws were assessed before training (control group 1) and after training (experimental group) and compared with 2 senior spine surgeons with >10 years' experience of pedicle screw insertion (control group 2).
  
  
  RESULTS
  The time of per pedicle screw insertion was 43.5±3.9 seconds in control group 1, 31.6±2.9 seconds in control group 2, and 50.8±3.7 seconds in experimental group. The relative position of the screw to the pedicle was graded regarding pedicle breach (I, no breach; II, <2 mm; III, 2-4 mm; IV, >4 mm). The pedicle breach grading I and II was 20 pedicle screws (20/56, 35.7%) in control group 1, 54 pedicle screws (54/56, 96.4%) in control group 2, and 44 pedicle screws (44/56, 78.6%) in the experimental group. There were significant differences between control group 1 and experimental group in the time of per pedicle screw insertion (P<0.001) and the rate of pedicle breach grading I and II (P<0.001). There were significant differences between control group 2 and experimental group in the time of per pedicle screw insertion (P<0.001) and the rate of pedicle breach grading I and II (P=0.004).
  
  
  CONCLUSIONS
  The simulator offers many helpful features to the surgeon with respect to the surgical trainee learning the basic technique of pedicle screw insertion, using free-hand technique or under the guiding of intraoperative fluoroscopy. The surgical skills of the junior surgeons can be significantly improved through the training of simulator.
authors: *Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Liaoning †Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing ‡State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang, China.
authors: Liangbi
authors: L
authors: Xiang
authors: Yue
authors: Y
authors: Zhou
authors: Hongwei
authors: H
authors: Wang
authors: He
authors: H
authors: Zhang
authors: Guoli
authors: G
authors: Song
authors: Yiwen
authors: Y
authors: Zhao
authors: Jianda
authors: J
authors: Han
authors: Jun
authors: J
authors: Liu
mesh_terms: D003198:Computer Simulation; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000193:education* / Q000379:methods*; D065289:Pedicle Screws; D011300:Preoperative Care / Q000193:education*; D012984:Software; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery; D066231:Surgeons / Q000193:education*; D014057:Tomography, X-Ray Computed