Introduction

Precise and efficient contouring of rods during posterior spinal instrumented fusion is essential to reduce hardware complications, improve the likelihood of achieving a solid arthrodesis, and minimize operative time and cost. Yet, surgical trainees receive little training on this topic. The purpose of the present study was to evaluate a novel standardized training program for teaching residents to bend rods.

Methods

We prospectively enrolled orthopedic surgery trainees at a single academic institution in a rod bending educational study. Upon enrollment, each participant completed a preparticipation survey indicating their postgraduate year and experience with rod bending. Participants then performed a timed rod bending test using a spinal fusion model designed to mimic a unilateral T7 to pelvis posterior instrumented fusion construct using 13 contemporary pedicle screws with polyaxial screw heads. Participants were required to bend a 6.0mm stainless steel rod into the screw heads using bar benders, in situ benders, a French bender, and coronal benders, and then affix the rod to the screw heads using set screws and drivers. This test was timed, with a maximum allotted time to complete the task of 20 minutes; if participants were unable to complete the task in the allotted time, then the number of incomplete set screws was recorded. After completion of the first rod bending test, participants were immediately randomized in a 1:1 ratio into one of two groups: Group 1 was provided with an educational curriculum regarding rod bending, and Group 2 did not receive any additional education. The educational curriculum included 1 video reviewing each rod bending instrument and its appropriate use and 2 videos of fellowship-trained spine surgeons providing instruction on appropriate rod bending technique. Three months after the first rod bending test, participants completed a second identical rod bending test and completed a post-participation survey.

Results

Fourteen trainees were enrolled. Six participants randomized to Group 1 and completed the educational curriculum between rod bending tests. Eight participants randomized to Group 2 and did not receive any rod bending education between tests. There were no differences identified between groups with regards to their pre- or post-participation survey responses (Table 1). During the first rod bending test, there was no difference in baseline characteristics between groups (Table 2). The education group experienced a significant improvement in the number of participants who completed the task (3 to 6, P=0.04) and the time required to complete the task (18:40 to 10:58; P<0.001). During the second rod bending test, the education group outperformed the non-education group in number of participants completing the task (100% vs 37.5%, P=0.01), time to complete the task (10:58 vs 17:11, P=0.005), and number of incomplete set screws (0 vs 3.4, P=0.03)

Discussion

Orthopedic surgery and neurosurgery trainees who received a dedicated educational curriculum regarding rod bending improved significantly in all measured metrics, while those who received no dedicated training failed to improve. This study both demonstrates the efficacy of this educational curriculum and identifies an avenue for improving resident education.