Secondary Logo

Institutional members access full text with Ovid®

The Role of Mixed Reality Simulation for Surgical Training in Spine

Phase 1 Validation

Coelho, Giselle, MD; Defino, Helton L.A., PhD, MD

doi: 10.1097/BRS.0000000000002856

Study Design. This study shows the first phase of validation of a new model for realistic training on spine surgery, conducted from January 2014 to November 2015.

Objective. To propose and validate a new tool for neurosurgical education, associating virtual and realistic simulation (mixed reality), for spine surgery.

Summary of Background Data. Surgical simulation is a relatively new filed that has a lot to offer to neurosurgical education. Training a new surgeon may take years of hands-on procedures, increasing the risk to patient's safety. The development of surgical simulation platforms is therefore essential to reducing the risk of potentially serious risks and improving outcome.

Methods. Sixteen experienced spinal surgeons evaluated these simulators and answered the questionnaire regarding the simulation as a beneficial education tool. They evaluated the simulators in regard to dissection by planes, identification of pathology (lumbar canal stenosis), instrumentation and simulation of cerebrospinal fluid (CSF) leak, and the relevant aspects of the computerized tomography (CT) imaging.

Results. The virtual and physical simulators for spine surgery were approved by an expert surgery team, and considered adequate for educational purposes. The proportion of the answers was estimated by the confidence intervals.

Conclusion. The surgery team considered that this virtual simulation provides a highly effective training environment, and it significantly enhances teaching of surgical anatomy and operative strategies in the neurosurgical field. A mixture of physical and virtual simulation provided the desired results of enhancing the requisite psychomotor and cognitive skills, previously acquired only during a surgical apprenticeship. The combination of these tools may potentially improve and abbreviate the learning curve for trainees, in a safe environment.

Level of Evidence: 3

Pediatric Neurosurgery Center/CENEPE – Beneficência Portuguesa Hospital, São Paulo, Brazil.

Address correspondence and reprint requests to Giselle Coelho, MD, Pediatric Neurosurgery Center / CENEPE – Beneficência Portuguesa Hospital, São Paulo, Brazil; E-mail:

Received 14 September, 2016

Revised 17 November, 2016

Accepted 14 December, 2016

The manuscript submitted does not contain information about medical device(s)/drug(s).

The SIEDI Research Institute funds were received in support of this work.

No relevant financial activities outside the submitted work.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.