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Examining impact forces during posterior spinal fusion to implement in a novel physics-driven virtual reality surgical simulator

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Abstract

This study aims to understand the impact forces that surgeons apply to the human spine during a posterior spinal fusion procedure towards the development of a novel spine surgical simulator for training medical residents. The foci of this study are impact forces during graft placement and spinal interbody cage insertion. This study examined the lumbar intervertebral discs of two male cadaveric specimens. Impact forces were collected during graft and spinal cage insertion over multiple levels. An impulse hammer and a camera were used to collect impact forces and displacements, respectively. The results demonstrated a logarithmic relationship between impact forces and cumulative displacement during graft placement. This was also observed between cumulative displacement and number of impacts during spinal cage insertion. A linear relationship was observed for the impact forces and number of impacts during graft placement. Results suggest that surgeons rely on the feedback experienced from impact forces during graft insertion to gauge the amount of graft that was placed in a specific area of the disc. Impact forces during cage insertion provide information about any encountered obstacles. When developing surgical simulators, designing the force feedback system should require modelling these behaviors to effectively impart corresponding skills on a trainee.

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References

  1. Dreischarf M, Schmidt H, Putzier M, Zander T (2015) Biomechanics of the L5–S1 motion segment after total disc replacement – influence of iatrogenic distraction, implant positioning and preoperative disc height on the range of motion and loading of facet joints. J Biomech 48:3283–3291. https://doi.org/10.1016/j.jbiomech.2015.06.023

    Article  PubMed  Google Scholar 

  2. Andersson GBJ (1998) Epidemiology of low back pain. Acta Orthop Scand 69:28–31. https://doi.org/10.1080/17453674.1998.11744790

    Article  Google Scholar 

  3. Eismont FJ, Norton RP, Hirsch BP (2014) Surgical management of lumbar degenerative spondylolisthesis. J Am Acad Orthop Surg 22:203–213. https://doi.org/10.5435/jaaos-22-04-203

    Article  PubMed  Google Scholar 

  4. DiPaola CP, Molinari RW (2008) Posterior lumbar interbody fusion. J Am Acad Orthop Surg 16:130–139

    Article  PubMed  Google Scholar 

  5. Deyo RA, Nachemson A, Mirza SK (2004) Spinal-fusion surgery—the case for restraint. The Spine Journal 4:S138–S142

    Article  Google Scholar 

  6. White AA, Panjabi MM (1990) Clinical biomechanics of the spine. Lippincott, Philadelphia

    Google Scholar 

  7. Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG (2010) Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 303:1259–1265. https://doi.org/10.1001/jama.2010.338

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Roberts KE, Bell RL, Duffy AJ (2006) Evolution of surgical skills training. World J Gastroenterol 12:3219–3224. https://doi.org/10.3748/wjg.v12.i20.3219

    Article  PubMed  PubMed Central  Google Scholar 

  9. Schizas C, Tzinieris N, Tsiridis E, Kosmopoulos V (2009) Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience. Int Orthop 33:1683–1688. https://doi.org/10.1007/s00264-008-0687-8

    Article  PubMed  Google Scholar 

  10. Silva PS, Pereira P, Monteiro P, Silva PA, Vaz R (2013) Learning curve and complications of minimally invasive transforaminal lumbar interbody fusion. 35:E7. https://doi.org/10.3171/2013.5.Focus13157

  11. Bono CM, Schoenfeld AJ (2017) Orthopaedic Surgery Essentials: Spine, 2nd edn. Wolters Kluwer/Lippincott Williams & Wilkins, Philadelphia

  12. Carlisle ER, Fischgrund JS (2009) Chapter 27 - bone graft and fusion enhancement. In: Errico TJ, Lonner BS, Moulton AW (eds) Surgical management of spinal deformities. W.B. Saunders, Philadelphia, pp 433–448

    Chapter  Google Scholar 

  13. Bhatia NN, Lee KH, Bui CN, Luna M, Wahba GM, Lee TQ (2012) Biomechanical evaluation of an expandable cage in single-segment posterior lumbar interbody fusion. Spine (Phila Pa 1976) 37:E79-85. https://doi.org/10.1097/BRS.0b013e3182226ba6

    Article  PubMed  Google Scholar 

  14. Rutherford EE (2007) Lumbar spine fusion and stabilization: hardware, techniques, and imaging appearances. Radiographics 27:1737

    Article  PubMed  Google Scholar 

  15. Holly LT, Schwender JD, Rouben DP, Foley KT (2006) Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications. 20:1. https://doi.org/10.3171/foc.2006.20.3.7

  16. Chitale R, Ghobrial GM, Lobel D, Harrop J (2013) Simulated lumbar minimally invasive surgery educational model with didactic and technical components. Neurosurgery 73(Suppl 1):107–110. https://doi.org/10.1227/neu.0000000000000091

    Article  PubMed  Google Scholar 

  17. Ghobrial GM, Hamade YJ, Bendok BR, Harrop JS (2015) Technology and simulation to improve patient safety. Neurosurgery Clinics 26:239–243

    PubMed  Google Scholar 

  18. Leblanc F, Champagne BJ, Augestad KM, Neary PC, Senagore AJ, Ellis CN, Delaney CP (2010) A comparison of human cadaver and augmented reality simulator models for straight laparoscopic colorectal skills acquisition training. J Am Coll Surg 211:250–255. https://doi.org/10.1016/j.jamcollsurg.2010.04.002

    Article  PubMed  Google Scholar 

  19. Levine RL, Kives S, Cathey G, Blinchevsky A, Acland R, Thompson C, Pasic R (2006) The use of lightly embalmed (fresh tissue) cadavers for resident laparoscopic training. J Minim Invasive Gynecol 13:451–456. https://doi.org/10.1016/j.jmig.2006.06.011

    Article  PubMed  Google Scholar 

  20. Ross HM, Simmang CL, Fleshman JW, Marcello PW (2008) Adoption of laparoscopic colectomy: results and implications of ASCRS hands-on course participation. Surg Innov 15:179–183. https://doi.org/10.1177/1553350608322100

    Article  PubMed  Google Scholar 

  21. Morgan M, Aydin A, Salih A, Robati S, Ahmed K (2017) Current status of simulation-based training tools in orthopedic surgery: a systematic review. J Surg Educ 74:698–716. https://doi.org/10.1016/j.jsurg.2017.01.005

    Article  PubMed  Google Scholar 

  22. Alaraj A, Tobin MK, Birk DM, Charbel FT (2013) Simulation in neurosurgery and neurosurgical procedures. In: Levine AI, DeMaria S, Schwartz AD, Sim AJ (eds) The comprehensive textbook of healthcare simulation. Springer New York, New York, NY, pp 415–423

    Chapter  Google Scholar 

  23. Eck JC, Vaccaro AR (2013) Surgical atlas of spinal operations. Jaypee Brothers Pvt. Ltd, New Delhi

    Google Scholar 

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Acknowledgements

The authors would like to thank their research partners CAE Inc., Montreal, Canada, and DePuy Synthes, Raynham, MA, USA. The authors would also like to thank Prof. Yvan Petit, Elisabeth Laroche, and Lucien Diotalevi, for their assistance and support during the experiments, at Hôpital du Sacré-Coeur de Montreal. The authors would like to thank Dr. Rodrigo Navarro, the surgeon who prepared the cadaveric specimen, participated in our experiments, and provided valuable insights towards successfully completing a spinal fusion.

Funding

This study is funded by the Natural Sciences and Engineering Research Council of Canada (NSERC) and MEDTEQ. S. Patel was financially supported by McGill Engineering Doctoral Award (MEDA) International during this study.

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Authors and Affiliations

  1. Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada

    Sneha Patel & Mark Driscoll

  2. Orthopaedic Research Lab, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada

    Jean Ouellet

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  1. Sneha Patel
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  2. Jean Ouellet
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Correspondence to Mark Driscoll.

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Patel, S., Ouellet, J. & Driscoll, M. Examining impact forces during posterior spinal fusion to implement in a novel physics-driven virtual reality surgical simulator. Med Biol Eng Comput 61, 1837–1843 (2023). https://doi.org/10.1007/s11517-023-02819-w

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