Navigation versus experience: providing training in accurate lumbar pedicle screw positioning

Area of Science:

• Spinal surgery
• Surgical training
• Medical technology

Background:

• Accurate spinal pedicle screw (PS) placement is crucial for spinal fusion and requires extensive surgical experience.
• Pedicle perforation risk is a concern with conventional techniques.
• Computer navigation offers real-time visual control during screw insertion.

Purpose of the Study:

• To evaluate if computer navigation can help trainees develop surgical skills for accurate pedicle screw placement comparable to experienced surgeons.
• To assess the safety and efficacy of computer-navigated PS insertion in surgical training.

Main Methods:

• A prospective study involving 18 patients where lumbosacral PS were placed.
• One side used conventional fluoroscopy by a senior surgeon; the contralateral side used computer navigation by a trainee.
• Trainee's skills were also assessed using freehand placement in foam models before and after the study.

Main Results:

• Trainee's pedicle screw placement accuracy and time significantly improved with computer navigation, reaching levels similar to the experienced surgeon.
• Intraoperative revisions remained low for both surgeon and trainee.
• No postoperative complications were reported.

Conclusions:

• Computer navigation facilitates safe and effective training for spinal pedicle screw insertion from the outset.
• Trainees can rapidly improve judgmental skills in PS placement using navigation.
• Skills acquired through navigated surgery are transferable to conventional techniques.