Asian Spine J.  2025 Apr;19(2):183-193. 10.31616/asj.2025.0050.

Development and validation of a cost-effective three-dimensional-printed cervical spine model for endoscopic posterior cervical foraminotomy training: a prospective educational study from Turkey

• Akbulut BB
• Çenberlitaş EE
• Bölük MS
• Yurtseven T
• Biçeroğlu H

• KMID: 2567393
• DOI: http://doi.org/10.31616/asj.2025.0050

Abstract

Study Design: Expanding upon established surgical simulation methods, we developed a fused deposition modeling three-dimensional (3D)-printed model of the C1–T1 vertebra for posterior cervical foraminotomy training that features silicone-based neural elements, polyurethane foam-based ligaments, and polyethylene terephthalate glycol vertebrae. Purpose: This study evaluated the effectiveness of a cost-efficient 3D-printed training model designed to help neurosurgical residents acquire fundamental skills in endoscopic posterior cervical foraminotomy while addressing the technique’s challenging learning curve and limited training resources. Overview of Literature: Only a few studies have investigated the efficacy of such a model.
Methods
Eight neurosurgery residents each with over 2 years of training completed four training sessions on two randomly assigned cervical spine levels using the newly developed 3D-printed model. A simple plumbing endoscope was used for real-time surgical visualization.
Results
Among the 64 completed surgical levels, left-sided procedures showed significantly higher insufficient decompression rates than did right-sided procedures (25.0% vs. 3.6%, p=0.002). However, no significant difference in overall complication rates was observed between sides (p=0.073). Surgical parameters remained consistent across sides, with no significant differences in operative duration. Brunner-Langer analysis revealed substantial improvements in operative duration (mean duration decrease from 21:42±2:15 to 6:33±0:42 minutes, p=0.004) and total complications (mean decrease from 2.1±0.8 to 0.4±0.5, p=0.007) across sessions. Although fluoroscopy timing showed marginal improvement (mean duration decrease from 2:12±1:15 to 0:55±0:23 minutes, p=0.057), the number of fluoroscopic images tended to decrease.
Conclusions
Our findings suggest that this novel 3D-printed cervical spine model could be a viable, low-cost option for neurosurgical training programs aiming to help residents develop essential endoscopic skills in a controlled setting. Facilitating early proficiency in posterior cervical foraminotomy can serve as a valuable intermediate step before transitioning to cadaveric models and clinical practice.

Keyword

Endoscopes; Residency; Minimally invasive surgical procedures; Three-dimensional printing; Simulation training