448 Virtual Reality Simulation of Lumbar Pedicle Screw Placement: A Multi-Institutional Pilot of a Self-Directed Training Adjunct

INTRODUCTION: Increasing pressures limit resident surgical autonomy. Innovative use of technology represents an opportunity to accelerate learning and revolutionize traditional training paradigms. Virtual reality (VR) is one such technology that may enhance neurosurgical training. METHODS: Twelve residents (six residents at two institutions, respectively) were given access to the VR simulation for home use for eight weeks. Simulated pedicle screw accuracy was recorded by the application and mixed effects logistic and linear regression was used to determine the impact of simulation experience on probability of accurate screw placement and pedicle breach distance, respectively. Additionally, participants were surveyed regarding confidence with the surgical anatomy and procedural steps of lumbar pedicle screw placement, as well as attitudes toward VR training. Responses before and after use of the simulation were compared in a pairwise fashion. RESULTS: Over the course of eight weeks of simulation, the participants simulated a total of 568 pedicle screws (mean 47.3 per participant). With increased experience in the simulation, the probability of accurate screw placement increased and pedicle breach distance decreased (p = 0.008 and 0.023, respectively). Participants’ reported confidence in surgical anatomy and procedural steps improved after simulation, and participants’ attitudes towards simulation were extremely positive. CONCLUSIONS: This VR simulation is a feasible, well-tolerated adjunct to standard intraoperative resident training that results in improved anatomic and procedural confidence. Simulated pedicle screw accuracy within the application also improved with experience. The translation of this improvement to physical pedicle screw placement will need to be assessed in future studies.