Development and validity evidence of an interactive 3D model for thoracic and lumbar spinal fractures pedagogy: a first step of validity study

Background

Thoracic and lumbar spinal fractures are common in trauma care, requiring accurate classification to guide appropriate treatment. While traditional teaching methods use static 2D images, there is a growing need for interactive tools to improve understanding. This study addresses the lack of interactive three-dimensional (3D) models for teaching the AO (Arbeitsgemeinschaft für Osteosynthesefragen) Spine classification for thoracic and lumbar fractures.

Hypothesis

A free and open-access interactive 3D model of thoracic and lumbar spinal fractures was developed. The study aimed to provide preliminary validity evidence. We hypothesized that this model would be a valid educational tool for teaching the AO Spine classification, receiving high scores from senior spine surgeons on a validation questionnaire regarding anatomical realism and pedagogical value. The primary endpoint was the percentage of surgeons rating the model ≥8/10 on the Likert scale for content validation. We hypothesized that the 3D model would be validated by at least 75% of participating senior spine surgeons (rating ≥8/10) for anatomical realism and pedagogical value.

Methods

The 3D model was created using the Blender® software, incorporating CT-scan images of a lumbar spine. AO Spine classification was used to recreate spinal fractures animations. The model could be used on any computer or smartphone, directly online. A total of 24 senior spine surgeons (5 professors, 6 fellows, 8 hospital practitioners, and 5 private practitioners) evaluated the 3D model using a structured questionnaire with seven Likert-scale items, assessing anatomical realism, fracture representation, adherence to the AO Spine classification, pedagogical value, and ease of use. A score of ≥8/10 was considered a positive validation. Group comparisons were made based on hospital activity and age.

Results

The 3D model was positively validated by 92% of surgeons for anatomical realism, 88% for fracture representation, and 92% for adherence to the AO Spine classification. The model’s educational value for junior residents was rated positively by 100% of participants. Six out of 24 surgeons (25%) rated the ease of navigation <8/10. Group comparisons revealed that university-affiliated surgeons rated the model higher overall (mean score 9.25/10) compared to private practitioners, who gave the lowest ratings (mean score 8.6/10). No significant correlation was found between age and ease of navigation (p = 0.948).

Discussion

The developed 3D model of thoracic and lumbar spine fractures is the first of its kind. It provides an innovative, open-access and freely online accessible tool for teaching the AO Spine classification. The findings demonstrate that it is a valid pedagogical tool for teaching the AO Spine classification, with strong support for its anatomical accuracy and pedagogical effectiveness. This study sets the stage for a future validation study with surgical residents.

Level of evidence

III.