Virtual reality surgical simulator training of residents and early-career surgeons for pedicle screw placement: a systematic review and meta-analysis.
Eric Pasqualotto, Tales Pasqualotto, Victor Hugo Pinheiro Lopes et al.
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In 30 seconds
This systematic review and meta-analysis included six randomized controlled trials comparing virtual reality (VR) simulation with conventional teaching for pedicle screw placement training in residents and early-career surgeons. Each study group comprised 54 trainees and 457 inserted screws. VR-trained participants had a higher rate of optimal Grade I placement (RR 1.36; 95% CI 1.15 to 1.61) and higher overall procedural success (RR 1.17; 95% CI 1.04 to 1.32). VR training was also associated with fewer placements across Grades II–IV and shorter screw penetration distances.
Key findings
- Optimal Grade I placement was more frequent with VR training than conventional training (RR 1.36; 95% CI 1.15 to 1.61).
- Overall procedural success was higher in the VR group (RR 1.17; 95% CI 1.04 to 1.32).
- VR training was associated with fewer Grade II (RR 0.61; 95% CI 0.45 to 0.85), Grade III (RR 0.07; 95% CI 0.02 to 0.30), and Grade IV placements (RR 0.16; 95% CI 0.03 to 0.90).
- VR-trained participants had shorter screw penetration distances and fewer displaced screws per resident.
Why it matters
Pedicle screw placement accuracy is a relevant training outcome, and the pooled trial findings suggest VR simulation can improve placement grades and procedural success compared with conventional teaching. The reductions in more severe cortical breaches also indicate potential educational value for practising technical skills in simulation. These results concern training performance and do not by themselves establish effects on patient outcomes.
What to keep in mind
The review included only six RCTs, with 54 trainees and 457 screws in each study group; the abstract does not report patient outcomes.