Simulated spinal durotomy repair for orthopaedic resident training: a perfusion-based porcine cadaveric specimen as an in vitro animal model.

Background: Training in delicate spinal dura mater suturing techniques poses significant challenges due to patient safety and medicolegal concerns, driving the need for alternative training methods beyond traditional mentorship models. This study aimed to introduce and validate a training model for orthopaedic residents using perfusion-based porcine spines to simulate intraoperative durotomy and subsequent repair.

Methods: Nine junior orthopaedic residents were invited to participate. Three attending orthopaedic spine surgeons were included in the control group. Fresh porcine spines were used for the simulation, and a perfusion-based system was implemented to replicate cerebrospinal fluid circulation and apply hydrostatic pressure to the dura. Durotomies were made and mended with 6-0 prolene sutures, and the participants' performance was assessed across six trials for repair speed and leakage pressure. Additionally, the self-confidence levels of the residents were analyzed before and after the training.

Results: While attending surgeons showed consistent performance across trials, residents demonstrated a 70% reduction in mean total time and a 62% increase in mean leakage pressure after training. Residents showed significant improvements in repair speed from Trial 4 and in repair quality from Trial 3 compared with Trial 1 as the baseline. The difference compared with attending surgeons became insignificant in repair speed from Trial 4 and in repair quality from Trial 2, indicating that the residents' performance approached that of the attending surgeons. Residents' self-confidence increased significantly from a mean pre-training score of 1.1 to a mean post-training score of 4.3.

Conclusions: This simulation model, which utilizes fresh porcine spines and a perfusion-based system, is an accessible, cost-effective, and high-fidelity training method for dural repair during spinal surgery.