Use of Cadaveric Models in Simulation Training in Spinal Procedures

  • Theodosios Stamatopoulos
  • Vijay Yanamadala
  • John H. Shin
Part of the Comprehensive Healthcare Simulation book series (CHS)


Traditionally, surgical skills are meant to be acquired through years of experience in the operating room (OR) on live patients. This chapter introduces the use of cadaveric models in spine surgery, how such laboratories are organized worldwide. Spine surgery is associated with increased morbidity due to the complexity of these surgical procedures, so the increasing need for improvement of postoperative results forces the physicians on enchasing the effectiveness of their surgical standards. Spine surgery’s high exacting nature is common ground due to the complex anatomy as well as the dangers surgeons can face intra- and postoperatively. Cadaveric training programs offer the infrastructure and the personnel to face this need through a combination of theoretical and practical training through up-to-date teaching, make a truly very meaningful advance to improve patient care, and improve the quality of spine surgery. Included in this chapter are the advantages and disadvantages of cadaveric spine surgery, as well as the methods through which spine surgeons are introduced to recognize the anatomical landmarks of each part of the spine and learn how to perform certain surgical procedures of the cervical, thoracic, and lumbar spine. Additionally, the new role of minimally invasive surgery is being presented and how training using cadavers can potentially expand our therapeutic options. Despite some limitations in this type of training, cadaver-based surgical skill learning courses are worldwide recognized as the gold standard in surgical training. New doctors, as well as medical professionals, are encouraged to practice spine surgery on cadaveric models, which gives them the best way to effectively improve their skills and make significant progress in achieving their treatment goals effectively.


Cadaver Spine surgery Cadaveric training Surgical techniques Minimally invasive surgery Learning curve Pedicle screws Complications Endoscopic surgery 


  1. 1.
    Perez-Cruet MJ, Balabhadra RSV, Samartzis D, Kim DH. Historical background of minimally invasive spine surgery. In: Kim DH, Fessler RG, Regan JJ, editors. Endoscopic spine surgery and instrumentation. New York: Thime; 2004. p. 3–18. Attaching top medical students to a career in Neurosurgery.Google Scholar
  2. 2.
    Mody MG, Nourbakhsh A, Stahl DL, Gibbs M, Alfawareh M, Garges KJ. The prevalence of wrong level surgery among spine surgeons. Spine. 2008;33:194–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Spinal disorders: fundamentals of diagnosis and treatment. Am J Neuroradiol. 2009.;
  4. 4.
    Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. 1983;8:817–31.CrossRefPubMedGoogle Scholar
  5. 5.
    Sclafani JA, Kim CW. Complications associated with the initial learning curve of minimally invasive spine surgery: a systematic review. Clin Orthop Relat Res. 2014;472:1711–7.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Gonzalvo A, Fitt G, Liew S, de la Harpe D, Turner P, Ton L, Rogers MA, Wilde PH. The learning curve of pedicle screw placement: how many screws are enough? Spine. 2009;34:E761–5.CrossRefPubMedGoogle Scholar
  7. 7.
    Kshettry VR, Mullin JP, Schlenk R, Recinos PF, Benzel EC. The role of laboratory dissection training in neurosurgical residency: results of a national survey. World Neurosurg. 2014;82:554–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Nwachukwu C, Lachman N, Pawlina W. Evaluating dissection in the gross anatomy course: correlation between quality of laboratory dissection and students’ outcomes. Anat Sci Educ. 2015;8:45–52.CrossRefPubMedGoogle Scholar
  9. 9.
    Harrop J, Lobel DA, Bendok B, Sharan A, Rezai AR. Developing a neurosurgical simulation-based educational curriculum: an overview. Neurosurgery. 2013;73(Suppl 1):25–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Jones R. Leonardo da Vinci: anatomist. Br J Gen Pract. 2012;62:319.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Smith A, Gagliardi F, Pelzer NR, Hampton J, Chau AM, Stewart F, Mortini P, Gragnaniello C. Rural neurosurgical and spinal laboratory setup. J Spine Surg. 2015;1:57–64.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Hayashi S, Naito M, Kawata S, Qu N. History and future of human cadaver preservation for surgical training: from formalin to saturated salt solution method. Anat Sci Int. 2016.
  13. 13.
    Tomlinson JE, Yiasemidou M, Watts AL, Roberts DJ, Timothy J. Cadaveric spinal surgery simulation: a comparison of cadaver types. Global Spine J. 2016;6:357–61.CrossRefPubMedGoogle Scholar
  14. 14.
    Coelho G, Warf B, Lyra M, Zanon N. Anatomical pediatric model for craniosynostosis surgical training. Childs Nerv Syst. 2014;30:2009–14.CrossRefPubMedGoogle Scholar
  15. 15.
    Benneker LM, Gisep A, Krebs J, Boger A, Heini PF, Boner V. Development of an in vivo experimental model for percutaneous vertebroplasty in sheep. Vet Comp Orthop Traumatol. 2012;25:173–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Gragnaniello C, Abou-Hamden A, Mortini P, Colombo EV, Bailo M, Seex KA, Litvack Z, Caputy AJ, Gagliardi F. Complex spine pathology simulator: an innovative tool for advanced spine surgery training. J Neurol Surg A Cent Eur Neurosurg. 2016;77:515–22.CrossRefPubMedGoogle Scholar
  17. 17.
    Suslu H. A practical laboratory study simulating the percutaneous lumbar transforaminal epidural injection: training model in fresh cadaveric sheep spine. Turk Neurosurg. 2012;22:701–5.PubMedGoogle Scholar
  18. 18.
    Turan Suslu H, Tatarli N, Hicdonmez T, Borekci A. A laboratory training model using fresh sheep spines for pedicular screw fixation. Br J Neurosurg. 2012;26:252–4.CrossRefPubMedGoogle Scholar
  19. 19.
    Berjano P, Villafañe JH, Vanacker G, Cecchinato R, Ismael M, Gunzburg R, Marruzzo D, Lamartina C. The effect of case-based discussion of topics with experts on learners’ opinions: implications for spinal education and training. Eur Spine J. 2016.
  20. 20.
    Kamel I, Barnette R. Positioning patients for spine surgery: avoiding uncommon position-related complications. World J Orthop. 2014;5:425–43.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Stambough JL, Dolan D, Werner R, Godfrey E. Ophthalmologic complications associated with prone positioning in spine surgery. J Am Acad Orthop Surg. 2007;15:156–65.CrossRefPubMedGoogle Scholar
  22. 22.
    DePasse JM, Palumbo MA, Haque M, Eberson CP, Daniels AH. Complications associated with prone positioning in elective spinal surgery. World J Orthop. 2015;6:351–9.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Chambers SB, Deehan DJ. Cadaveric surgical training improves surgeon confidence. The Bulletin of the RCS. 2015.Google Scholar
  24. 24.
    Turnbull IM, Brieg A, Hassler O. Blood supply of cervical spinal cord in man: a microangiographic cadaver study. J Neurosurg. 1966;24:951–65.CrossRefPubMedGoogle Scholar
  25. 25.
    Breig A, Turnbull I, Hassler O. Effects of mechanical stresses on the spinal cord in cervical spondylosis: a study on fresh cadaver material. J Neurosurg. 1966;25:45–56.CrossRefPubMedGoogle Scholar
  26. 26.
    Harrop JS, Aarabi B, Shaffrey C, Dvorak M, Fisher C. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One. 2012;7:e32037.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Ebraheim NA, Jabaly G, Xu R, Yeasting RA. Anatomic relations of the thoracic pedicle to the adjacent neural structures. Spine. 1997;22:1553.CrossRefPubMedGoogle Scholar
  28. 28.
    Kessler J, Moriggl B, Grau T. The use of ultrasound improves the accuracy of epidural needle placement in cadavers. Surg Radiol Anat. 2014.
  29. 29.
    Bergeson RK, Schwend RM, DeLucia T, Silva SR. How accurately do novice surgeons place thoracic pedicle screws with the free hand technique? Spine. 2008.
  30. 30.
    Oh CH, Yoon SH, Kim YJ, Hyun D, Park H-CC. Technical report of free hand pedicle screw placement using the entry points with junction of proximal edge of transverse process and lamina in lumbar spine: analysis of 2601 consecutive screws. Korean J Spine. 2013;10:7–13.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Gautschi OP, Schatlo B, Schaller K, Tessitore E. Clinically relevant complications related to pedicle screw placement in thoracolumbar surgery and their management: a literature review of 35,630 pedicle screws. Neurosurg Focus. 2011;31:E8.CrossRefPubMedGoogle Scholar
  32. 32.
    Lonner BS, Auerbach JD, Estreicher MB, Kean KE. Thoracic pedicle screw instrumentation: the learning curve and evolution in technique in the treatment of adolescent idiopathic scoliosis. Spine. 2009.
  33. 33.
    Shriver MF, Zeer V, Alentado VJ, Mroz TE, Benzel EC, Steinmetz MP. Lumbar spine surgery positioning complications: a systematic review. Neurosurg Focus. 2015;39:E16.CrossRefPubMedGoogle Scholar
  34. 34.
    Goldstein CL, Phillips FM, Rampersaud YR. Comparative effectiveness and economic evaluations of open versus minimally invasive posterior or transforaminal lumbar interbody fusion: a systematic review. Spine. 2016;41(Suppl 8):S74–89.PubMedGoogle Scholar
  35. 35.
    Shriver MF, Xie JJ, Tye EY, Rosenbaum BP, Kshettry VR, Benzel EC, Mroz TE. Lumbar microdiscectomy complication rates: a systematic review and meta-analysis. Neurosurg Focus. 2015;39:E6.CrossRefPubMedGoogle Scholar
  36. 36.
    Abuzayed B, Tuna Y, Gazioglu N. Thoracoscopic anatomy and approaches of the anterior thoracic spine: cadaver study. Surg Radiol Anat. 2012.
  37. 37.
    Isaacs RE, Podichetty VK, Sandhu FA, Santiago P, Spears JD, Aaronson O, Kelly K, Hrubes M, Fessler RG. Thoracic microendoscopic discectomy: a human cadaver study. Spine. 2005;30:1226–31.CrossRefPubMedGoogle Scholar
  38. 38.
    Liu J, Napolitano JT, Ebraheim NA. Systematic review of cervical pedicle dimensions and projections. Spine. 2010;35:E1373–80.CrossRefPubMedGoogle Scholar
  39. 39.
    Srikantha U, Khanapure KS, Jagannatha AT, Joshi KC, Varma RG, Hegde AS. Minimally invasive atlantoaxial fusion: cadaveric study and report of 5 clinical cases. J Neurosurg Spine. 2016:1–6.Google Scholar
  40. 40.
    Ludwig SC, Kramer DL, Balderston RA, Vaccaro AR, Foley KF, Albert TJ. Placement of pedicle screws in the human cadaveric cervical spine: comparative accuracy of three techniques. Spine. 2000;25:1655–67.CrossRefPubMedGoogle Scholar
  41. 41.
    Dixon D, Darden B, Casamitjana J, Weissmann KA, Cristobal S, Powell D, Baluch D. Accuracy of a dynamic surgical guidance probe for screw insertion in the cervical spine: a cadaveric study. Eur Spine J. 2016.
  42. 42.
    Du Jerry Y, Aichmair A, Kueper J, Label TWDR. Biomechanical analysis of screw constructs for atlantoaxial fixation in cadavers: a systematic review and meta-analysis. J Neurosurg Spine. 2015;22(2):151–61.CrossRefGoogle Scholar
  43. 43.
    Majid K, Moldavsky M, Khalil S, Gudipally M. An in-vitro biomechanical study evaluating cervical extension plates for stabilizing degenerated adjacent levels. Clin Spine Surg. 2016.
  44. 44.
    Reis MT, Reyes PM, Crawford NR. Biomechanical assessment of anchored cervical interbody cages: comparison of 2-screw and 4-screw designs. Neurosurgery. 2014;10(Suppl 3):412–7; discussion 417.Google Scholar
  45. 45.
    Liu J, Hao L, Suyou L, Shan Z, Maiwulanjiang M. Biomechanical properties of lumbar endplates and their correlation with MRI findings of lumbar degeneration. J Biomech. 2016;49:586–93.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Theodosios Stamatopoulos
    • 1
    • 2
  • Vijay Yanamadala
    • 3
  • John H. Shin
    • 3
  1. 1.Department of NeurosurgeryMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  2. 2.CORE-Center for Orthopedic Research at CIRI-AUThAristotle University Medical SchoolThessalonikiUSA
  3. 3.Department of NeurosurgeryMassachusetts General Hospital, Harvard Medical SchoolBostonUSA

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