Neurosurgical Resident Skill Development using a Novel Simulator-Based Anterior Cervical Discectomy and Fusion Curriculum

Faith C Robertson; Corinna C Zygourakis; Janet Y Wu; Karen E Malacon; C Coumans Jean-Valery; Ganesh M Shankar; Christopher J Stapleton; Giannantonio Spena; Carlo Giussani; Brian V Nahed; Federico Nicolosi; Grazia Menna

doi:10.1016/j.wneu.2025.124257

Neurosurgical Resident Skill Development using a Novel Simulator-Based Anterior Cervical Discectomy and Fusion Curriculum

World Neurosurg. 2025 Jul 4:124257. doi: 10.1016/j.wneu.2025.124257. Online ahead of print.

Affiliations

¹ Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
² Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA.
³ Department of Neurosurgery, San Matteo Polyclinic IRCCS Foundation, Pavia, Italy.
⁴ School of Medicine, University of Milano-Bicocca; Department of Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
⁵ Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy. Electronic address: mennagrazia@gmail.com.

PMID: 40619056
DOI: 10.1016/j.wneu.2025.124257

Abstract

Introduction and background: Simulation-based training is increasingly integrated into surgical education as a method to enhance technical skills in a safe and reproducible environment. This dual-institution pilot study - conducted within the neurosurgery residency programs at Massachusetts General Hospital (MGH) and Stanford University (SU) - evaluates the feasibility and impact of integrating a 3-D printed anterior cervical discectomy and fusion (ACDF) simulator (UpSurgeon S.r.l), alongside spaced repetition learning in a novel simulator training curriculum.

Methods: In the preliminary phase, 21 participants (n=12 MGH, n=9 SU residents) performed a 1-level ACDF procedure on the simulator. Each procedure was timed, video-recorded, and included an anatomy identification test and survey. Afterwards, participants attended serial lab practice sessions using the ACDF simulators. In the final phase, participants repeated the ACDF procedure under the same conditions (timed, video-recorded) as in the preliminary phase.

Results: After completing the simulator training curriculum, average time from skin incision to retractor docking decreased by 29.6% (from 14:00 to 9:51 minutes, p = 0.018), cage placement time decreased by 70% (from 4:45 to 1:25 mins, p = 0.0058), and plate and screw placement time decreased by 27.9% (from 8:54 to 6:25 mins, p = 0.028). Anatomy assessment scores improved by an average of 1.6 points out of a maximum score of 10 (p = 0.008). Surveys indicated that residents agreed (66.7%) or strongly agreed (22.2%) that the simulator helped increase their neurosurgical skills and that may be considered for future curricular integration pending further validation (88.9%).

Conclusion: Incorporating a 3D-printed ACDF simulator alongside spaced repetition learning in a novel training curriculum suggests potential for improving procedural timing and anatomical knowledge in neurosurgical trainees.

Keywords: Education; neurosurgery; simulation; spaced repetition; surgical training; technical skills.