title: The use of computer-assisted surgery as an educational tool for the training of orthopedic surgery residents in pedicle screw placement: a pilot study and survey among orthopedic residents.
abstract: BACKGROUND
  The training of orthopedic residents in adequate pedicle screw placement is very important. We sought to investigate orthopedic residents' perspectives on the use of computer-assisted surgery (CAS) in a training trial.
  
  
  METHODS
  Orthopedic residents were randomly assigned to independently place a screw using the free-hand technique and the CAS technique on 1 of 3 cadavers (Cobb angles 5º, 15º and 67º) at randomly selected thoracolumbar vertebral levels. All residents were blinded to their colleagues' pedicle screw placements and were asked to complete a short questionnaire at the end of the session to evaluate their experience with CAS. We obtained CT images for each cadaver to assess pedicle screw placement accuracy and classified placement as A) screw completely in pedicle, B) screw < 2 mm outside pedicle, C) screw 2-4 mm outside pedicle, or D) screw > 4 mm outside pedicle.
  
  
  RESULTS
  Twenty-four orthopedic residents participated in this trial study. In total, 65% preferred using the free-hand technique in an educational setting even though most (60%) said that CAS is safer. The main reason for free-hand technique preference was the difficult technical aspects encountered with CAS. In addition, accuracy of pedicle screw placement in this trial showed that 5 screws were classified as A or B (safe zone) and 19 as grade C or D (unsafe zone) using the free-hand technique compared with 15 and 9, respectively, using CAS (p= 0.008).
  
  
  CONCLUSIONS
  Orthopedic residents perceived CAS as safe and demonstrated improved accuracy in pedicle screw placement in a single setting. However, the residents preferred the free-hand technique in an educational stetting owing to the difficult technical aspects of CAS.
authors.affiliation: From the McGill University Health Centre, Division of Orthopaedics Surgery, Montreal, QC (Aoude, Alhamzah, Fortin, Jarzem, Ouellet, Weber); the McGill Scoliosis and Spine Centre, McGill University, Montreal, QC (Fortin, Jarzem, Ouellet, Weber); and the Department of Surgery, McGill University, Montreal, Canada (Jarzem, Ouellet, Weber).
authors.forename: Ahmed
authors.initials: A
authors.lastname: Aoude
authors.affiliation: From the McGill University Health Centre, Division of Orthopaedics Surgery, Montreal, QC (Aoude, Alhamzah, Fortin, Jarzem, Ouellet, Weber); the McGill Scoliosis and Spine Centre, McGill University, Montreal, QC (Fortin, Jarzem, Ouellet, Weber); and the Department of Surgery, McGill University, Montreal, Canada (Jarzem, Ouellet, Weber).
authors.forename: Hamzah
authors.initials: H
authors.lastname: Alhamzah
authors.affiliation: From the McGill University Health Centre, Division of Orthopaedics Surgery, Montreal, QC (Aoude, Alhamzah, Fortin, Jarzem, Ouellet, Weber); the McGill Scoliosis and Spine Centre, McGill University, Montreal, QC (Fortin, Jarzem, Ouellet, Weber); and the Department of Surgery, McGill University, Montreal, Canada (Jarzem, Ouellet, Weber).
authors.forename: Maryse
authors.initials: M
authors.lastname: Fortin
authors.affiliation: From the McGill University Health Centre, Division of Orthopaedics Surgery, Montreal, QC (Aoude, Alhamzah, Fortin, Jarzem, Ouellet, Weber); the McGill Scoliosis and Spine Centre, McGill University, Montreal, QC (Fortin, Jarzem, Ouellet, Weber); and the Department of Surgery, McGill University, Montreal, Canada (Jarzem, Ouellet, Weber).
authors.forename: Peter
authors.initials: P
authors.lastname: Jarzem
authors.affiliation: From the McGill University Health Centre, Division of Orthopaedics Surgery, Montreal, QC (Aoude, Alhamzah, Fortin, Jarzem, Ouellet, Weber); the McGill Scoliosis and Spine Centre, McGill University, Montreal, QC (Fortin, Jarzem, Ouellet, Weber); and the Department of Surgery, McGill University, Montreal, Canada (Jarzem, Ouellet, Weber).
authors.forename: Jean
authors.initials: J
authors.lastname: Ouellet
authors.affiliation: From the McGill University Health Centre, Division of Orthopaedics Surgery, Montreal, QC (Aoude, Alhamzah, Fortin, Jarzem, Ouellet, Weber); the McGill Scoliosis and Spine Centre, McGill University, Montreal, QC (Fortin, Jarzem, Ouellet, Weber); and the Department of Surgery, McGill University, Montreal, Canada (Jarzem, Ouellet, Weber).
authors.forename: Michael H
authors.initials: MH
authors.lastname: Weber
mesh_terms: D001863:Bone Screws; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D019637:Orthopedic Procedures / Q000193:education*; D009985:Orthopedics / Q000193:education*; D010865:Pilot Projects; D025321:Surgery, Computer-Assisted / Q000193:education*