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. 2026 Jan 3;26(1):173.
doi: 10.1186/s12909-025-08514-8.

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

Lin Han #  1   2 , An Wang #  3 , Xu Su #  1 , Yang Li  2 , Yuchen Qin  4 , Huipeng Zhou  1 , Zhiwei Wang  1 , Xiaoxi Wang  5 , Yajun Cheng  6 , Wenbo Lin  7
Affiliations

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

Lin Han et al. BMC Med Educ. .

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12909-025-08514-8.

Keywords: 3D printing; Education; Resident training; Spine surgery; Surgical simulation.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Approval was obtained from the Ethics Committee of Shanghai Changzheng Hospital and written informed consents were obtained from all of the participants in the study. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Consent for publication: declaration. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The reconstruction of lumbosacral vertebrae and neural tissues. A Lumbosacral vertebrae. B Neural tissues consist of dural sac and nerve roots. C Assembly congsists of lumbosacral vertebrae and neural tissues
Fig. 2
Fig. 2
The design of PLIF surgical training model. A A box for holding PLIF surgical training model. B A base with anatomic structure for immobilizing lumbosacral model in prone position. C The lumbosacral vertebrae. D The nerve shell serves to encapsulate the neural model. E The PLIF surgical training model assembly
Fig. 3
Fig. 3
The design steps of nerve shell model. A Reconstruction of neural tissues including dural sac and nerve roots. B A 1 mm-thick shell overlay onto the neural model. C Trim the cranial and caudal ends of the spinal cord and the terminal portions of nerve roots. D The finalized design of nerve shell serves to encapsulate the neural model
Fig. 4
Fig. 4
The rapid prototyping process of lumbosacral vertebrae and nerve shell. A lumbosacral vertebrae are separated along the longitudinal middle plane. B neural shell undergoes customized segmentation
Fig. 5
Fig. 5
3D-printed PLIF training model with the structure of lumbosacral vertebrae, spinal nerves and intervertebral discs
Fig. 6
Fig. 6
Simulated PLIF surgery on training model
See this image and copyright information in PMC

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