Background Spine pedicle screw insertion is technically demanding, with potentially serious risks if screws are misplaced, and an established learning curve of approximately 70 screws placed before there is a significant reduction in screw misplacement. Despite this most units continue to teach screw insertion for the first time in live surgery, both in the UK and worldwide. This study was a single blinded comparison of cadaver types to simulate screw insertion.
Methodology Three cadaver types – Thiel, Crosado and Formaldehyde were positioned prone and a posterior approach to the spine performed. The spines were all exposed by a single surgeon. Experienced spinal surgeons placed screws in each cadaver type sequentially and gave feedback on the tissue quality and feel using a modified Likert scale.
Results Thiel cadavers rated most highly for soft tissue feel and appearance with a median score of 6. Crosado cadavers rated most highly for bony properties, with a median score of 6. Formaldehyde cadavers rated poorly for soft tissue feel, appearance and bony qualities with median scores of 2, 2.5 and 3.5 respectively.
Conclusions There is a strong argument that pedicle screw insertion should be taught away from the operating theatre but this will have significant cost implications. Cadaveric screw simulation offers the most realistic simulation, with Thiel and Crosado cadavers both rating highly for their properties. Further work is now needed on a larger scale to further explore this valuable resource in surgical training.
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