Implementing “Free-Hand” Technique Training for Pedicle Screw Instrumentation in Neurosurgical Residency

Abstract

Introduction: The anatomical studies conducted in recent decades made possible the emergence of “free-hand” technique for pedicle screw instrumentation of the thoracic-lumbar spine based solely on anatomical parameters. However, the potential risks associated with such technique revealed the immediate need to create educational models for surgical training. Methods: After an interdisciplinary partnership, two anatomicspecimens were submitted to instrumentation of the thoracolumbar spine. In the sequence they were submitted to fine-slice CT-scan, and, finally, to the decompression of the lumbar spinal canal in order to verify the accuracy pedicle screw placement both on the anatomical and radiological level. Results: Overall, 28 intact vertebral bodies were instrumented (T5-S1) in two specimens (a total amount of 62 pedicle screws). Overall, there were only four critical perforations. Considering the accuracy rates for each specimen separately, the number of violations decreased from the first (32% of misplaced screws) to the second instrumented specimens (25%). A more surprising learning curve was noted when considering the lower thoracic spine separately (37,5% versus 12,5%). Conclusions: The authors demonstrate that incorporating the training of pedicle screw instrumentation in routine neurosurgical residency is a cost-effective educational method, which enables young neurosurgeons to practice these skills in the laboratory before proceeding to the operating room.