Resident Physician Mayo Clinic Rochester Rochester, Minnesota, United States
Introduction: Safe patient positioning, incisional planning, surgical exposure, and bony decompression are crucial skills that junior neurosurgical residents must obtain in order to advance operative cases in spine. While numerous educational resources exist for senior residents and spine fellows, there are significantly fewer opportunities for those starting residency.
Methods: A two-day, simulated intraoperative experience was created using operating room instruments/equipment and fresh cadaveric dissection. Critical skills included marking out lumbar incisions using iliac crest anatomy, identifying surgical instruments (Cobb, Leksell rongeur, Kerrison, various retractors), subperiosteal dissection, identification and preservation of the supraspinous/interspinous ligaments and facet capsules, locating the lateral edge of the pars, planning the lateral margins of a laminectomy, and tying fascial sutures. Residents completed a 15-question survey regarding their level of comfort with each skill (rated 1-5; 1=could not attempt; 5=comfortable performing on my own) both before and after the course. They also completed questions regarding their participation in spine cases as well as the amount of independence given to them by senior surgeons. Student’s t-tests were performed to compare the difference in scores for each subsection.
Results: A total of 4 neurosurgical interns were included in the pilot study. Prior to the course, no residents were comfortable attempting exposure down to the posterior elements or marking out an incision for an L3-L5 laminectomy. Participants demonstrated significantly increased scores in incisional planning (2.00 to 4.75; P< 0.01), components of safe laminectomy exposure (1.25 to 4.00; P< 0.01), and planning for decompressive bone work (2.00 to 4.75; P< 0.01). All residents described increased involvement in the operating room after completing the course.
Conclusion : A novel spinal surgical skills course significantly increased the confidence and perceived competence of neurosurgical interns. Early emphasis of targeted techniques may accelerate surgical development and involvement in the operating room.
