Physical and Virtual Simulation in Spine Surgery Training

Study Design. Narrative review of the literature related to physical and virtual simulation in spine surgery training. Objective. The purpose of this narrative review was to provide an overview of the development of simulated spine surgery, its current role, and future potential use in the training of surgical skills. Summary of Background Data. Residents and fellows are expected to become proficient in an ever-increasing number of spine surgery techniques. While the standard training for surgery has traditionally involved the use of cadaveric specimens, there are inherent challenges with the specimens including cost, storage, shipping, and anatomical abnormalities or inconsistent quality. Various synthetic and virtual spine models have been produced upon which surgical skills can be practiced. Methods. For this narrative review, a comprehensive literature search was performed to identify relevant articles reporting on the use of physical and/or virtual surgery simulators in the training of spine surgeons. Results. To date, a variety of study formats and simulated models have been described. Study participants most commonly include neurosurgical and/or orthopaedic surgery residents. Despite the heterogeneity of the studies, almost all have found benefit from the simulated training on a range of variables including pedicle screw placement, procedure time, and trainee confidence. Conclusion. Modern advancements in material engineering and computer science have led to high-fidelity virtual and physical spine surgery simulation models. These models provide a safe environment for practice while addressing some of the limitations inherent to the modern surgical training model. While the literature consistently demonstrates a benefit of simulation compared to traditional teaching, more information is needed to determine if simulation training translates to improved real-world surgical outcomes. Future work should focus on establishing objective benchmarks for competency and expert status.