Evaluation of a mixed reality navigation simulator for training of minimally invasive interventions of the spine: a pilot didactic plan

PURPOSE: Minimally invasive interventions of the spine (MISP) involve high-risk procedures. Lack of accuracy in infiltrations or poor screw placement can lead to severe neurological, vascular, and visceral injuries. This requires better training methods for residents, including surgical simulation, to reduce patient risk and lead to more efficient surgeries with lower error rates and improved clinical outcomes. METHODS: A mixed-reality simulator for training in MISP procedures was evaluated. The simulator combines two navigation modalities: (1) virtual reality fluoroscopy simulation and (2) mixed reality with augmented and virtual reality scenes. Two interventions were selected for simulation: pure facet infiltration and transpedicular screw placement. A pilot training program was designed and implemented, comparing the two navigation modalities: fluoroscopy simulation vs. mixed-reality navigation. Ten orthopedic residents participated in the study. Their performance was evaluated by using simulator metrics. Their perceived experience was assessed through a specifically designed questionnaire. RESULTS: Residents improved overall execution times during mixed reality navigation. In particular, greater success in screw placements with shorter execution times during mixed reality navigation compared to fluoroscopy simulation. Similarly, they also achieved greater accuracy in the infiltration procedure. The questionnaire reveals that residents have a positive evaluation of the simulator and find it valuable for training purposes. CONCLUSION: Compared to fluoroscopy simulation, residents found it easier to perform tasks with the mixed reality guide in perceiving and understanding anatomy, safe pathways, and correct target locations. Overall, the simulator was deemed valuable for training. This motivates further research on stratified programs and their benefits, possibly starting with mixed reality, followed by fluoroscopy simulation. Also provides useful information for improving the simulation, including better visual feedback and patient-specific cases.