Simulation Training in Pedicle Preparation and Screw Insertion in Pediatric Spinal Deformity

Abstract

Pedicle screw segmental instrumentation has become the gold standard for spinal deformity correction for both the pediatric and adult populations. The thought of placing screws through tiny boney channels in the spinal column can be a daunting task for trainees. The goal in spine surgery instrumentation is similar to other orthopaedic subspecialities—safe passage of screws through the bone. Yet, the potential consequences of pedicle breaches and malpositioned instruments/screws are what give pedicle preparation and screw insertion an appropriately heightened sense of care and apprehension. Important anatomical structures lie around the pedicles of the spine, with the spinal cord, nerve roots, epidural veins, lungs, kidneys, and major vessels being just some of the structures that lurk outside of the spine’s osseous anatomy.

In 2007, we implemented power pedicle screw preparation and screw insertion to improve safety for both the surgeon and patient. A recent multicenter study of early adopters demonstrated the safety of this technique in 22,209 screws across six institutions. As we have taught this technique to fellow surgeons throughout the world, inevitably the question would always arise, “Do you let your residents do that?”. The answer was always an emphatic, YES. However, we began to explore ways in which we could improve our trainees’ education on pedicle screw insertion, both manual and power, given the complexity of the osseous anatomy in pediatric spinal deformity cases.