Establishing validity of the fundamentals of spinal surgery (FOSS) simulator as a teaching tool for orthopedic and neurosurgical trainees

Nitin Bhatia, Winnie A. Palispis, Timur Urakov, Jordan Gruskay, Justin Haghverdian, Daniel S. Yang, Jennifer Uong, Todd Albert, Alexander Vaccaro, Allan D. Levi, Ranjan Gupta

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


BACKGROUND CONTEXT: Pedicle screw placement is a demanding surgical skill as a spine surgeon can face challenges including variations in pedicle morphology and spinal deformities. Available CT simulators for spine pedicle placement can be very costly and hands-on cadaver courses are limited by specimen availability and are not readily accessible. PURPOSE: To conduct validation of a simulated training device for essential spine surgery skills. DESIGN: Cross-sectional, empirical study of physician performance on a surgical simulator model. SAMPLE: Spine attending physicians and residents from four different academic institutions across the United States. OUTCOME MEASURES: Performance metrics on two surgical simulator tasks. METHODS: After IRB approval, an inexpensive ($30) simulator was developed to test two main psychomotor tasks (1) creation of the pedicle screw path with a standard gearshift probe without cortical breaks and (2) the ability to palpate for the presence or absence of cortical breaches as well as determine the location of wall defects. Orthopedic and neurosurgery residents (N=72) as well as spine attending surgeons (N=26) participated from four different institutions. To test construct validity, performance metrics were compared between participants of different training status through one-way analysis of variance and linear regression analysis, with significance set at p<.05. RESULTS: Spine attending surgeons consistently scored higher than the residents, in the screw trajectory task with triangular base (p=.0027) and defect probing task (p=.0035). In defect probing, performance improved with linear trend by number of residency training years with approaching significance (p=.0721). In that task, independent of institutional affiliation, PGY-2 residents correctly identified an average of 1.25±0.43 fewer locations compared with attending physicians (p=.0049). More than 80% of the spine attendings reported they would use the simulator for training purposes. CONCLUSIONS: This low-cost fundamentals of spine surgery simulator detected differences in performances between spine attending surgeons and surgical residents. Programs should consider implementing a simulator such as fundamentals of spine surgery to assess and develop pedicle screw placement ability outside of the operating room.

Original languageEnglish (US)
Pages (from-to)580-589
Number of pages10
JournalSpine Journal
Issue number4
StatePublished - Apr 2020


  • Construct validity
  • Low-cost
  • Pedicle screw
  • Psychomotor skills
  • Resident education
  • Skills assessment
  • Spine surgery
  • Surgical simulator
  • Training tool

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology


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