SpineBox – the first simulator for training spine surgery

The COVID-19 pandemic has forced the healthcare system to implement innovation, not only in medicine, but also in medical didactics. Due to the current situation, medical students were excluded from practice because schools suspended contact with patients and conferences and training were canceled. Cooperation of medics and engineers resulted in the creation of new, groundbreaking projects that will enable development in the field of medicine.

Experts from the Faculty of Neurosurgery Mayo Clinic – B.R.A.I.N. (Biotechnology Research and Innovation Neuroscience) Laboratory created the project of the first SpineBox simulator, used to educate residents and medical students in the field of spine anatomy and placing cap screws. The project was created to provide institutions around the world with a low-budget and easily accessible spine surgery simulator, as well as to encourage other laboratories to create innovative medical education tools.

The study was conducted by five co-authors: Clifton and Damon, and neurosurgeons from Mayo Clinic: Mark Pichelmann, Eric Nottmeier and Fidel Valero-Moreno. Clifton and Damon’s goal was to create a free model that would be portable and easily accessible to apprentices around the world.

The simulator can be printed in parts on any desktop 3D printer. It is dedicated to residents of neurosurgery and orthopedics for training purposes. The total cost of creating such a print is less than $ 10, and the STL file can be downloaded for free from the Autodesk Online Gallery.

The first conceptual model was printed from ABS on a Raise 3D Pro Plus printer using FDM technology. It took 30 hours to print, and the material used to create one model cost $ 9.68.

The whole process of creating the simulator was to obtain an anonymous computed tomography (CT) scan of the lumbar spine from an adult patient to create a 3D model. It maps the anatomy of the vertebrae and their surface. The CT scan was loaded into the open-source 3D Slicer program, where five lumbar vertebrae (L1-L5) were manually selected. The vertebrae were separated at the places of inter-processional joints in order to individually segment each element. Each of the five coils was converted to STL format and loaded into CAD Meshmixer to construct a virtual space for coil models.

For a better reproduction of the real situation, a top layer, made of polyurethane foam, was created, which covered the spine model. Then the medical trainees do not see the spine model, and the situation becomes more realistic. To perform the procedure on the model, cut the foam with a scalpel and use surgical retractors to separate soft tissues, allowing the view of the operating cavity.

The pandemic period has proved the importance of access to educational resources that are fully mobile and independent of hospitals. For now, 10 complete SpineBox models have been created, but more are still being researched. More and more institutions are buying desktop 3D printers, so experts say the need for more open-source and cheap simulators will grow steadily.