Novel Barium-Enhanced 3-Dimensional-Printed Spine Model for Pedicle Screw Training: A Cost-Effective Solution and Educational Validation.

Abstract

Background and objectives: Training in pedicle screw placement is crucial for neurosurgery residents, yet access to high-fidelity training models is often limited by cost and availability. This study introduces a novel, cost-effective barium-enhanced 3-dimensional (3D)-printed L4-5 spine model visible under fluoroscopy, aiming to validate its effectiveness as a training tool for novice residents in pedicle screw placement.

Methods: A barium-enhanced 3D-printed L4-5 spine model was developed to simulate human bone density and provide radiopacity under fluoroscopy. Ten neurosurgery residents with no prior experience in pedicle screw placement participated in a structured training program using this model. Each resident completed three training sessions, placing four pedicle screws per session, totaling 120 screw placements. Surgical duration, screw placement accuracy, and fluoroscopy usage were recorded. Screw placement accuracy was assessed by two independent blinded evaluators using both a visual grading method and the computed tomography-based Gertzbein-Robbins classification.

Results: The analysis demonstrated significant improvement in surgical time across sessions (P < .0001), decreasing from 20:44 ± 4:32 minutes to 13:17 ± 4:04 minutes. The median number of fluoroscopic images decreased from 8.5 (range: 5-18) to 6.0 (range: 5-10), although not statistically significant (P = .312). Visual assessment scores improved, with median breach scores decreasing from 0.25 (0.00-3.00) to 0.00 (0.00-0.25). Similarly, the median Gertzbein-Robins grades improved from 0.50 (0.12-2.88) to 0.12 (0.00-0.62). Visual and computed tomography-based assessments showed excellent correlation (intraclass correlation coefficients = 0.978, 95% CI: 0.953-0.989, P < .001).

Conclusion: The barium-enhanced 3D-printed spine model ($1.61/session) provides a highly cost-effective training tool for novice residents, demonstrating significant improvements in surgical efficiency. Although accuracy measures showed promising trends, more extensive studies may be needed to establish definitive improvements in placement precision. The model's radiopacity allows for realistic fluoroscopic imaging, bridging the gap between basic models and more expensive alternatives, which is particularly valuable in resource-limited settings.