Medical Student University of Pennsylvania Philadelphia, Pennsylvania, United States
Introduction: Accurate pedicle screw placement is a fundamental competency of neurosurgical training and practice, and is one of the quintessential operative technique taught during a spine surgical training. New educational tools such as augmented reality (AR) can potentially be used to enhance the acquisition and refinement of this skillset.
Methods: In this cadaveric study, thoracic and lumbosacral pedicle screws were placed by 3 subjects with different levels of neurosurgical experience: a spine fellowship-trained board-certified neurosurgeon, a PGY-4 neurological surgery resident, and a 2nd year medical student with no prior surgical experience. Screws were both placed freehand and with AR assistance using VisAR (Novarad, Provo, UT).
Results: A total of 64 pedicle screws were placed. Successful screw placement without pedicle breach was similar between freehand and AR-assisted placement for the attending neurosurgeon (freehand: 11/12, AR: 10/12) and PGY-4 resident (freehand: 8/9, AR: 9/9). However, AR resulted in more accurate pedicle screw placement in thoracic and lumbar spine for the inexperienced medical student (freehand: 4/11, AR: 8/11), with a significantly lower Gertzbein-Robbins score (12 vs. 5, p = 0.019). Additionally, while the medical student’s Gertzbein-Robbins score was significantly higher than the PGY-4 resident and attending for freehand placement (p = 0.012 and p = 0.011, respectively), this difference was not present in AR-assisted placement.
Conclusion : AR is an effective technology for training inexperienced students and residents in pedicle screw placement, and effectively shortens the learning curve. Our pilot study shows that a 2nd-year medical student using AR assistance can nearly double their screw placement accuracy and score comparably to attending and resident neurosurgeons. AR holds a promising place in neurosurgical education, and further studies are indicated to elucidate the benefits of AR-assisted training in additional techniques and practice settings.
