Biomimetic 3-Dimensional-Printed Posterior Cervical Laminectomy and Fusion Simulation: Advancements in Education Tools for Trainee Instruction.

Surgical proficiency is classically acquired through live experience in the operating room. Trainee exposure to cases and complex pathologies is highly variable between training programs.1 Currently, there is no standard for neurosurgical skill assessment for specific operative techniques for trainees. Cadaveric simulation has been used to demonstrate surgical technique and assess resident skill but often presents a significant financial and facility burden.2-4 Three-dimensional (3D) printing is an alternative to cadaveric tissue in providing high-quality representation of surgical anatomy; however, this technology has significant limitations in replicating conductive soft tissue structures for the use of cauterization devices and haptic learning for proper tissue manipulation.5-7 Our team has combined novel synthesis methods of conductive thermoplastic polymerization and 3-dimensional-printed cervical spine models to produce a layered biomimetic simulation that provides cost-effective and anatomically accurate education for neurosurgical trainees (Video 1). This is accomplished through virtual modeling and layered simulator construction methods by placing the individual polymer layers according to anatomic location of the simulated in vivo structures. The consistency of the thermoplastics can be tailored according to the desired soft tissue structures (skin, fat, fascia, muscle) according to the degree of polymerization. This cost-effective simulation was designed to represent the material and biomechanical properties of the cervical spine cortico-cancellous interface, as well as individual soft tissue components with specific anatomic details of muscle tendinous and ligamentous insertion. These features allow for representative start-to-finish surgical simulation that has not yet been made widely available to neurosurgical training programs.