TRADITIONAL TRAINING VERSUS VIRTUAL REALITY AND HAPTIC ENABLED SIMULATION TRAINING FOR POSTERIOR CERVICAL SCREW PLACEMENT

Objective: Simulation-based training is a technique, which evokes or replicates substantial aspects of the real world in a fully interactive fashion and replaces and amplifies real experiences with guided ones, which are generally immersive. Materials and Methods: Twenty-five junior surgeons (20 orthopedic, 5 neurosurgeon) who were not involved in previous posterior cervical spine instrumentation participated in this study. Before the procedures, all surgeons received 2-hour lecture about cervical spine anatomy and screw insertion techniques. Group 1 (10 surgeons) underwent virtual reality simulation with haptic feedback for 20 min, group 2 (15 surgeons) were attended video sessions with experienced surgeons for 20 min for posterior cervical instrumentation training. After, all junior surgeons applied C1-2 screw, C3-4-5 lateral mass screws, and C6-7 cervical pedicle screws to saw bones. All saw bones underwent computerized tomography (CT) imaging and a blinded radiologist reviewed the CT images. Results: Group 1 applied 70 screws and group 2 applied 105 screws. Group 1 showed a 12% misplacement ratio, while group 2 showed a 19% misplacement ratio and 4% rate of a possible vertebral artery trace penetration (p=0.026). Conclusion: According to the results acquired from this study, we observed a lower cervical spine screw misplacement ratio in those who trained with VR based haptic enabled simulation before performing cervical posterior instrumentation.