Complex Spine Pathology Simulator: An Innovative Tool for Advanced Spine Surgery Training

Background: Technical advancements in spine surgery have made possible the treatment of increasingly complex pathologies with less morbidity. Time constraints in surgeons' training have made it necessary to develop new training models for spine pathology. Objective To describe the application of a novel compound, Stratathane resin ST-504 derived polymer (SRSDP), that can be injected at different spinal target locations to mimic spinal epidural, subdural extra-axial, and intra-axial pathologies for the use in advanced surgical training.

Material and Methods: Fresh-frozen thoracolumbar and cervical spine segments of human and sheep cadavers were used to study the model. SRSDP is initially liquid after mixing, allowing it to be injected into target areas where it expands and solidifies, mimicking the entire spectrum of spinal pathologies.

Results: Different polymer concentrations have been codified to vary adhesiveness, texture, spread capability, deformability, and radiologic visibility. Polymer injection was performed under fluoroscopic guidance through pathology-specific injection sites that avoided compromising the surgical approach for subsequent excision of the artificial lesion. Inflation of a balloon catheter of the desired size was used to displace stiff cadaveric neurovascular structures to mimic pathology-related mass effect.

Conclusion: The traditional cadaveric training models principally only allow surgeons to practice the surgical approach. The complex spine pathology simulator is a novel educational tool that in a user-friendly, low-cost fashion allows trainees to practice advanced technical skills in the removal of complex spine pathology, potentially shortening some of the aspects of the learning curve of operative skills that may otherwise take many years to acquire.