Pedicle Screw Insertion Surgical Simulator

  • Zhechen Du
  • Reihard Zeller
  • David WangEmail author
  • Karl Zabjek
Conference paper
Part of the Lecture Notes in Computer Science book series (LNCS, volume 10917)


Scoliosis is a sideway spinal deformity. If the curvature is measured to be more than 50\(^{\circ }\), surgery is required to straighten the spine. Pedicle screw insertion is a procedure that requires the placement of screws from the pedicle into the vertebral body. A rod is used to connect all the pedicle screws. The spine is straightened during the connection process. One of the most common techniques used for pedicle screw insertion is called the free hand technique, where the surgeon creates a screw channel by manually probing into the spine. The surgeon relies strongly on haptics feedback. However, small changes in force or direction can cause the probe to breach out of the spine. If the breach reaches the spine medial, the spinal cord could be damaged. Even experienced surgeons can not prevent breach.

In this paper, a pedicle screw insertion simulator is developed which combines visual and haptics sensation to recreate the channel creation process of the surgery. The device includes a linear actuator and a rotary motor. The simulator is tuned to four different surgical scenarios by 2 expert surgeons. Ten additional surgeons are asked to participate in the clinical study. Four research questions were examined: 1. Can experience help the surgeon improve correct breach recognition rate? 2. Can experience help the surgeon improve overall correct scenario recognition rate? 3. Is there any performance difference between surgeons with different experience levels? 4. Can the simulation trials become a learning tool for the simulation tasks? It was concluded that there is no statistically significant relationship between the wrong breach or total wrong recognition rate and surgical experience. Furthermore, there is statistical significance in the hard probing scenario between surgical experience and vertical force variance. Lastly, ANOVA analysis is used to examine breach force and velocity performance between three trials to evaluate learning with increase trials. The results are close to being statistical significant.


Virtual reality Scoliosis Haptic Surgical simulator Surgery Pedicle screw insertion 


  1. 1.
    Cassidy, J.D., Carroll, L.J., Côté, P.: The Saskatchewan health and back pain survey: the prevalence of low back pain and related disability in Saskatchewan adults. Spine 23(17), 1860–1866 (1998)CrossRefGoogle Scholar
  2. 2.
    Manchikanti, L., Singh, V., Datta, S., Cohen, S.P., Hirsch, J.A.: Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Physician 12(4), E35–E70 (2008)Google Scholar
  3. 3.
  4. 4.
    Sud, A., Tsirikos, A.I., et al.: Current concepts and controversies on adolescent idiopathic scoliosis: Part I. Indian J. Orthop. 47(2), 117 (2013)CrossRefGoogle Scholar
  5. 5.
  6. 6.
    Hicks, J.M., Singla, A., Shen, F.H., Arlet, V.: Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine 35(11), E465–E470 (2010)CrossRefGoogle Scholar
  7. 7.
  8. 8.
    Silbermann, J., Riese, F., Allam, Y., Reichert, T., Koeppert, H., Gutberlet, M.: Computer tomography assessment of pedicle screw placement in lumbar and sacral spine: comparison between free-hand and O-arm based navigation techniques. Eur. Spine J. 20(6), 875–881 (2011)CrossRefGoogle Scholar
  9. 9.
    Mattei, T., Meneses, M., Milano, J., Ramina, R.: “Free-hand” technique for thoracolumbar pedicle screw instrumentation: critical appraisal of current “state-of-art”. Neurol. India 57(6), 715–721 (2009).;year=2009;volume=57;issue=6;spage=715;epage=721;aulast=Mattei;t=6CrossRefGoogle Scholar
  10. 10.
    Kim, Y.J., Lenke, L.G., et al.: Thoracic pedicle screw placement: free-hand technique. Neurol. India 53(4), 512 (2005)CrossRefGoogle Scholar
  11. 11.
    Gelalis, I.D., Paschos, N.K., Pakos, E.E., Politis, A.N., Arnaoutoglou, C.M., Karageorgos, A.C., Ploumis, A., Xenakis, T.A.: Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur. Spine J. 21(2), 247–255 (2012)CrossRefGoogle Scholar
  12. 12.
    Samdani, A.F., Ranade, A., Sciubba, D.M., Cahill, P.J., Antonacci, M.D., Clements, D.H., Betz, R.R.: Accuracy of free-hand placement of thoracic pedicle screws in adolescent idiopathic scoliosis: how much of a difference does surgeon experience make? Eur. Spine J. 19(1), 91–95 (2010)CrossRefGoogle Scholar
  13. 13.
    Lehman Jr., R.A., Lenke, L.G., Keeler, K.A., Kim, Y.J., Cheh, G.: Computed tomography evaluation of pedicle screws placed in the pediatric deformed spine over an 8-year period. Spine 32(24), 2679–2684 (2007)CrossRefGoogle Scholar
  14. 14.
    Luciano, C.J., Banerjee, P.P., Sorenson, J.M., Foley, K.T., Ansari, S.A., Rizzi, S., Germanwala, A.V., Kranzler, L., Chittiboina, P., Roitberg, B.Z.: Percutaneous spinal fixation simulation with virtual reality and haptics. Neurosurgery 72, A89–A96 (2013)CrossRefGoogle Scholar
  15. 15.
  16. 16.
    Gasco, J., Patel, A., Ortega-Barnett, J., Branch, D., Desai, S., Kuo, Y.F., Luciano, C., Rizzi, S., Kania, P., Matuyauskas, M., et al.: Virtual reality spine surgery simulation: an empirical study of its usefulness. Neurol. Res. 36(11), 968–973 (2014)CrossRefGoogle Scholar
  17. 17.
    Xing, Q., Chen, J.X., Li, J., Moshirfar, A., Theiss, M.M., Wei, Q.: A real time haptic simulator of spine surgeries. In: Proceedings of the 21st ACM Symposium on Virtual Reality Software and Technology, pp. 121–124. ACM (2015)Google Scholar
  18. 18.
    Moafimadani, S.: Haptic training simulator for pedicle screw insertion in scoliosis surgery. Master’s Thesis, University of WaterlooGoogle Scholar
  19. 19.
    Leung, R.: Design of a haptic simulator for pedicle screw insertion in pediatric scoliosis surgery. Master’s thesis, University of TorontoGoogle Scholar
  20. 20.
    Zeller, R.: Scoliosis surgery experiment and test data.
  21. 21.
  22. 22.
    Klatzky, R.L., Lederman, S.J., Reed, C.: There’s more to touch than meets the eye: the salience of object attributes for haptics with and without vision. J. Exp. Psychol. Gen. 116(4), 356 (1987)CrossRefGoogle Scholar
  23. 23.
  24. 24.
  25. 25.
    Du, Z.: Pedicle screw insertion surgical simulator. Master’s thesis, University of WaterlooGoogle Scholar
  26. 26.
    Natrella, M.: NIST/SEMATECH e-Handbook of Statistical Methods (2010)Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Zhechen Du
    • 1
  • Reihard Zeller
    • 2
  • David Wang
    • 1
    Email author
  • Karl Zabjek
    • 3
  1. 1.University of WaterlooWaterlooCanada
  2. 2.Toronto SickKids HospitalTorontoCanada
  3. 3.University of TorontoTorontoCanada

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