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. 2022 Aug 6;12(1):13517.
doi: 10.1038/s41598-022-17512-5.

Vacuum curette lumbar discectomy mechanics for use in spine surgical training simulators

Trevor Cotter  1   2 , Rosaire Mongrain  1 , Mark Driscoll  3   4
Affiliations

Vacuum curette lumbar discectomy mechanics for use in spine surgical training simulators

Trevor Cotter et al. Sci Rep. .

Abstract

Simulation in surgical training is a growing field and this study aims to understand the force and torque experienced during lumbar spine surgery to design simulator haptic feedback. It was hypothesized that force and torque would differ among lumbar spine levels and the amount of tissue removed by ≥ 7%, which would be detectable to a user. Force and torque profiles were measured during vacuum curette insertion and torsion, respectively, in multiple spinal levels on two cadavers. Multiple tests per level were performed. Linear and torsional resistances of 2.1 ± 1.6 N/mm and 5.6 ± 4.3 N mm/°, respectively, were quantified. Statistically significant differences were found in linear and torsional resistances between all passes through disc tissue (both p = 0.001). Tool depth (p < 0.001) and lumbar level (p < 0.001) impacted torsional resistance while tool speed affected linear resistance (p = 0.022). Average differences in these statistically significant comparisons were ≥ 7% and therefore detectable to a surgeon. The aforementioned factors should be considered when developing haptic force and torque feedback, as they will add to the simulated lumbar discectomy realism. These data can additionally be used inform next generation tool design. Advances in training and tools may help improve future surgeon training.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Concorde Clear tools used in the test. (a) shows the straightened tool (left) used in the linear test as well as the normal bent tool (right) used in the torsional test. (b) shows the test setup and motion, where the tool is inserted (1) into the intervertebral disc (IVD) and twisted (2). The linear test involved motions 1 and 2, while the torsional test was only motion 2. IVDs are marked.
Figure 2
Figure 2
Examples of linear (a) and torsional (b) tests with extracted peak and resistance values for the first trial of the right side of C2 L3L4. The torsional test was performed at a 5 mm depth. Schematics of the tool orientation within the intervertebral disc (IVD) are shown.
Figure 3
Figure 3
Force peak and linear resistance comparisons.
Figure 4
Figure 4
Linear (a,b) and torsional (c,d) peak and resistance values as correlated to intervertebral disc (IVD) height.
Figure 5
Figure 5
Torque peak and torsional resistance comparisons.
See this image and copyright information in PMC

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