title: Complex Spine Pathology Simulator: An Innovative Tool for Advanced Spine Surgery Training.
abstract: BackgroundTechnical advancements in spine surgery have made possible the treatment of increasingly complex pathologies with less morbidity. Time constraints in surgeons' training have made it necessary to develop new training models for spine pathology.ObjectiveTo describe the application of a novel compound, Stratathane resin ST-504 derived polymer (SRSDP), that can be injected at different spinal target locations to mimic spinal epidural, subdural extra-axial, and intra-axial pathologies for the use in advanced surgical training.Material and MethodsFresh-frozen thoracolumbar and cervical spine segments of human and sheep cadavers were used to study the model. SRSDP is initially liquid after mixing, allowing it to be injected into target areas where it expands and solidifies, mimicking the entire spectrum of spinal pathologies.ResultsDifferent polymer concentrations have been codified to vary adhesiveness, texture, spread capability, deformability, and radiologic visibility. Polymer injection was performed under fluoroscopic guidance through pathology-specific injection sites that avoided compromising the surgical approach for subsequent excision of the artificial lesion. Inflation of a balloon catheter of the desired size was used to displace stiff cadaveric neurovascular structures to mimic pathology-related mass effect.ConclusionThe traditional cadaveric training models principally only allow surgeons to practice the surgical approach. The complex spine pathology simulator is a novel educational tool that in a user-friendly, low-cost fashion allows trainees to practice advanced technical skills in the removal of complex spine pathology, potentially shortening some of the aspects of the learning curve of operative skills that may otherwise take many years to acquire.
authors.affiliation: Department of Neurosurgery, George Washington University, Washington, District of Columbia, United States.
authors.forename: Cristian
authors.initials: C
authors.lastname: Gragnaniello
authors.affiliation: Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Amal
authors.initials: A
authors.lastname: Abou-Hamden
authors.affiliation: Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Mortini
authors.affiliation: Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Elena V
authors.initials: EV
authors.lastname: Colombo
authors.affiliation: Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Bailo
authors.affiliation: Department of Neurosurgery, Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Seex
authors.affiliation: Department of Neurosurgery, George Washington University, Washington, District of Columbia, United States.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Litvack
authors.affiliation: Department of Neurosurgery, George Washington University, Washington, District of Columbia, United States.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Caputy
authors.affiliation: Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Gagliardi
mesh_terms: D000818:Animals; D002983:Clinical Competence; D006801:Humans; D019635:Neurosurgical Procedures / Q000193:education*; D012756:Sheep; D013122:Spinal Diseases / Q000601:surgery*; D013131:Spine / Q000601:surgery*