Abstract
Vertebral augmentation techniques are used to stabilize impacted vertebrae. To minimize intraoperative risks, a solid education of surgeons is desirable. Thus, to improve education of surgeons as well as patient safety, the development of a high-fidelity simulator for the surgical training of cement augmentation techniques was initiated. The integrated synthetic vertebrae should be able to provide realistic haptics during all procedural steps. Synthetic vertebrae were developed, tested and validated with reference to human vertebrae. As a further reference, commercially available vertebrae surrogates for orthopedic testing were investigated. To validate the new synthetic vertebrae, characteristic mechanical parameters for tool insertion, balloon dilation pressure and volume were analyzed. Fluoroscopy images were taken to evaluate the bone cement distribution. Based on the measurement results, one type of synthetic vertebrae was able to reflect the characteristic parameters in comparison to human vertebrae. The different tool insertion forces (19.7 ± 4.1, 13.1 ± 0.9 N, 1.5 ± 0.2 N) of the human reference were reflected by one bone surrogate (11.9 ± 9.8, 24.3 ± 3.9 N, 2.4 ± 1.0 N, respectively). The balloon dilation pressure (13.0 ± 2.4 bar), volume (2.3 ± 1.5 ml) of the synthetic vertebrae were in good accordance with the human reference (10.7 ± 3.4 bar, 3.1 ± 1.1 ml). Cement application forces were also in good accordance whereas the cement distribution couldn’t be reproduced accurately. Synthetic vertebrae were developed that delivered authentic haptics during transpedicular instrument insertion, balloon tamp dilation and bone cement application. The validated vertebra model will be used within a hybrid simulator for minimally invasive spine surgery to educate and train surgeons.
Highlights
People often suffer from a fracture of an osteoporotic vertebral body, when they complain about suddenly occurring non-traumatic back pain
In 2010 about 27 million Europeans were affected by vertebral compression fractures (VCF) caused by osteoporosis [1], which mostly affect the thoracolumbar region [2]
Risks associated with kyphoplasty are the breakage of a pedicle since typically bigger needles are used in this maneuver to enable placement of the balloon tamp in the vertebral body [6]
Summary
People often suffer from a fracture of an osteoporotic vertebral body, when they complain about suddenly occurring non-traumatic back pain. The transpedicular approach represents the classic approach for most augmentation techniques since the pedicle offers an anatomical landmark for needle targeting and minimize the risk of damage for surrounding structures It is considered only a safe technique as long as an intrapedicular pathway is maintained [4] and an inaccurate needle placement may lead to injuries of the nerve root, the spinal cord or even adjacent organs, e.g. the lungs [5]. Another complication for both techniques is cement leakage. This is only the case after full inflation [7]
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