A novel and cost-effective 3D-printed model enabling stepwise simulation workflows of posterior lumbar interbody fusion for resident training - a pilot feasibility study

Lumbosacral vertebral models with intervertebral discs and anatomical nerve structures were made by 3D printing technology to improve orthopedic residents’ surgical skills in posterior lumbar interbody fusion (PLIF) simulation training. In contrast to conventional spinal models limited to pedicle screw insertion training, this study introduces an innovative synthetic simulator that integrates anatomically precise lumbosacral vertebrae, branching spinal nerves, compressible intervertebral discs, and layered soft tissue structures (dermal-muscular layers) through computer-aided design and 3D printing. This technical advancement achieves high-fidelity anatomical replication, thereby enabling stepwise simulation of complete posterior lumbar interbody fusion (PLIF) workflows. Then, the residents in the 3D printing group share identical opportunities for learning PLIF surgical skills in clinical operation with those in the control group, while practicing additional simulated PLIF surgery utilizing 3D printing models. A rating scale for simulated PLIF surgery was designed and the variables were compared between the two groups. The 3D printing group got significant higher scores in the total score, operative time, screw placement accuracy, and avoidance of spinal dural sac and nerve roots injury than the control group. The 3D printing technology and soft tissue simulated by colored clay is helpful for orthopedic residents to improve their surgical skills in simulated lumbar fusion surgery.