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Peer-reviewedCC BY 4.0European Journal of Orthopaedic Surgery & Traumatology

Virtual reality surgical simulator training of residents and early-career surgeons for pedicle screw placement: a systematic review and meta-analysis

  • Eric Pasqualotto1
  • Tales Pasqualotto2
  • Victor Hugo Pinheiro Lopes3
  • Laura Lunelli4
  • Lucas Loiola Santos5
5 affiliations
  1. 1Programa de Pós-Graduação em Cirurgia Translacional, Universidade Federal de São Paulo, São Paulo, Brazil
  2. 2Departamento de Medicina, University Alto Vale do Rio do Peixe, Caçador, Brazil
  3. 3Departamento de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil
  4. 4Departamento de Medicina, Universidade do Sul de Santa Catarina, Palhoça, Brazil
  5. 5Departamento de Cirurgia, Divisão de Neurocirurgia, Servidores do Estado University Hospital, Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil., Rio de Janeiro, Brazil
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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.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00590-026-05008-1.

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Cite

BibTeXRIS
BibTeX
@article{pasqualotto2026virtual,
  title = {{Virtual reality surgical simulator training of residents and early-career surgeons for pedicle screw placement: a systematic review and meta-analysis}},
  author = {Eric Pasqualotto and Tales Pasqualotto and Victor Hugo Pinheiro Lopes and Laura Lunelli and Lucas Loiola Santos},
  journal = {European Journal of Orthopaedic Surgery \& Traumatology},
  year = {2026},
  month = oct,
  doi = {10.1007/s00590-026-05008-1},
  url = {https://doi.org/10.1007/s00590-026-05008-1},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Virtual reality surgical simulator training of residents and early-career surgeons for pedicle screw placement: a systematic review and meta-analysis
AU  - Eric Pasqualotto
AU  - Tales Pasqualotto
AU  - Victor Hugo Pinheiro Lopes
AU  - Laura Lunelli
AU  - Lucas Loiola Santos
PY  - 2026
DA  - 2026/10/27
JO  - European Journal of Orthopaedic Surgery & Traumatology
DO  - 10.1007/s00590-026-05008-1
UR  - https://doi.org/10.1007/s00590-026-05008-1
AB  - 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.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00590-026-05008-1.
SN  - 1633-8065
SN  - 1432-1068
ER  -