Virtual reality surgical simulator training of residents and early-career surgeons for pedicle screw placement: a systematic review and meta-analysis
In brief
VR training raises optimal pedicle screw placement by 36% versus conventional training
Across six randomized trials, virtual reality-trained residents and early-career surgeons had a 36% higher rate of optimally placed screws and a 17% higher overall procedural success rate than trainees receiving conventional instruction. They also had fewer misplaced screws, but the trials included only 54 trainees per group, and whether improved simulator performance translates to better patient outcomes remains unknown.
- Journal
- European journal of orthopaedic surgery & traumatology : orthopedie traumatologie (Q1)
- Published
- 27 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Eric Pasqualotto, Tales Pasqualotto, Victor Hugo Pinheiro Lopes, Laura Lunelli, Lucas Loiola Santos
- PMID
- 42944906
- DOI
- 10.1007/s00590-026-05008-1
Why clinicians should know about it
- Picked for Spine Surgery (paper of the day, 29 October 2026): Meta-analysis of randomized trials on pedicle screw placement training
Abstract
PURPOSE: To evaluate the effectiveness of Virtual reality (VR) simulation training compared with traditional teaching methods for residents and early-career surgeons training in pedicle screw insertion. METHODS: PubMed, Embase, and the Cochrane Library were systematically searched from inception to December 2025. Randomized controlled trials (RCTs) comparing VR simulator training with traditional training approaches for pedicle screw placement in residents and early-career surgeons were included. A random-effects model was applied to pool outcomes, with treatment effects expressed as mean differences or risk ratios with 95% confidence intervals. RESULTS: A total of six RCTs were included, with 54 trainees and 457 screws inserted in each study group. Pooled analyses demonstrated that residents and early-career surgeons trained with VR simulation achieved a significantly higher rate of optimal (Grade I) pedicle screw placement than those receiving conventional training (RR 1.36; 95% CI 1.15 to 1.61). Conversely, VR training was associated with significantly lower rates of Grade II (RR 0.61; 95% CI 0.45 to 0.85), Grade III (RR 0.07; 95% CI 0.02 to 0.30), and Grade IV screw placements (RR 0.16; 95% CI 0.03 to 0.90), indicating consistent reductions across all severities of cortical breach. Overall procedural success was significantly higher in the VR group (RR 1.17; 95% CI 1.04 to 1.32). Furthermore, VR-trained residents and early-career surgeons demonstrated shorter screw penetration distances and fewer displaced screws per resident. CONCLUSIONS: These findings indicate that VR simulation training significantly enhances accuracy and safety-related outcomes in resident and early-career surgeons' pedicle screw placement training.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.