In this article, the authors propose a novel procedure for designing a customized 3D-printed surgical template to guide surgeons in inserting screws into the sacral zone during arthrodesis surgeries. The template is characterized by two cylindrical guides defined by means of trajectories identified, based on standard procedure, via an appropriate Computer-Aided-Design (CAD)-based procedure. The procedure is based on the definition of the insertion direction by means of anatomical landmarks that enable the screws to take advantage of the maximum available bone path. After 3D printing, the template adheres perfectly to the bone surface, showing univocal positioning by exploiting the foramina of the sacrum, great maneuverability due to the presence of an ergonomic handle, as well as a break system for the two independent guides. These features make the product innovative. Thanks to its small size and the easy anchoring, the surgeon can simply position the template on the insertion area and directly insert the screws, without alterations to standard surgical procedures. This has the effect of reducing the overall duration of the surgery and the patient’s exposure to X-rays, and increasing both the safety of the intervention and the quality of the results.

The most common type of spine instrumentation is the pedicle screw fixation. The recent literature shows how customized drilling templates help surgeons to perform the surgery better. This work aims to validate the design of a customized template for inserting lumbar pedicle screw via a procedure based on rapid prototyping and reverse engineering techniques and to show the benefits. The novelties of this template are its low-invasive sizes, its design based on a patented algorithm, which calculates the sizes of the screws and the optimal insertion direction, the engage/disengage system, and the adaptability to every kind of surgeon’s kit. Accuracy of pedicle screw location, surgery duration, and X-ray exposition have been used to evaluate the performances of the template. Mono-centric in vivo trial was performed. Twenty patients (8 women and 12 men) were enrolled randomly corresponding to sixty vertebrae treated with spinal arthrodesis (30 with and 30 without templates). Accuracy of the screw positioning and reduction in both surgery duration and patients’ exposure to X-rays achieved excellent results because the time spent on the insertion of pedicle screws via the surgical template was cut down by about 63%, while the number of X-ray shots was reduced by about 92%. The proposed template performed better than the standard approach and could be helpful both for skilled and novice surgeons.

Spinal surgery demands exceptional theoretical knowledge and practical skills, with pedicle screw procedures posing significant risks due to proximity to critical anatomical structures. This study validates a virtual reality (VR) simulation platform for training in pedicle screw arthrodesis using patient-specific vertebral drilling templates. The practical simulation of a specific case study was evaluated with both neurosurgical residents and medical students. Results demonstrate that while experienced residents completed simulated procedures significantly faster than students ( p < 0.01), these latter ones showed marked improvement across consecutive training sessions ( p < 0.001). The most substantial performance gains occurred between the first and second trials, highlighting the rapid learning curve facilitated by the VR environment. System Usability Scale assessments revealed high satisfaction with the simulation platform, with participants emphasizing the value of risk-free repetitive practice. Qualitative feedback from experienced participants confirmed the precision and realism of the training environment as critical factors contributing to their efficiency. This validation confirms that VR simulation platforms offer an effective training environment for complex spinal procedures, providing a safe space for skill development before clinical application, particularly when incorporating innovative surgical aids such as patient-specific drilling templates.