Introduction of a Cost-effective 3d-printed Simulation Device for Anterior Lumbar Interbody Fusion

Introduction: In recent years, neurosurgery has continued to experience a surge in spinal operations, with a previous study citing an increase from 68.0% to 76.8% of spine procedures relative to cranial and peripheral nerve operations from 2006 to 2013. There has been a 168.5% increase in the number of Anterior lumbar interbody fusion (ALIF) procedures from 2007 to 2014. To better prepare neurosurgical trainees for spinal operations and supplement hands-on intraoperative experience, we developed a 3D-printed simulation device to imitate ALIF using affordable materials.

Methods: This simulation was designed using 3D modeling software and 3D-printed with PLA filament. A model spine from L3-S2 was created using a lumbar CT scan from a de-identified patient and manipulated to simulate an anterior approach to the interbody disc space. 10% ballistic gelatin was used for the trainee to practice discectomy. Polyurethane foam was included on the top of the box to simulate soft tissue. Initial materials cost under $50, with $10 to replace the disc material and model spine for continued use.

Results: We successfully created a cost-effective neurosurgical training simulation for the ALIF procedure. This device can be reused with low additional costs, while allowing the trainee to continually practice the technical skills required for an anterior lumbosacral approach. This can be supplemented with surgical tools available in neurosurgery departments, such as screws and interbody grafts. Performance can be measured through extent of disc resection and time to interbody placement.

Conclusion : Although intraoperative experience remains the gold standard of neurosurgical training, simulation devices have been explored in recent years to supplement and enhance technical skills outside the operating room. Unlike other simulations, such as virtual reality and cadaveric models, a cost-effective and reusable 3D-printed device may provide a useful alternative for trainees to practice their neurosurgical techniques in a low-stress environment.