Article Figures & Data
Figures
- FIG 1.
Puncturing the spinal cord. The photograph demonstrates the result of puncturing the inner latex balloon, which represents the spinal cord. Red dye returns from the spinal needle.
- FIG 2.
Constructed cervical phantom model. The photograph shows the fully-constructed phantom model. The cervical spine model is covered with polyalginate. There is a latex tube running through the spinal canal of the cervical model, with an inner latex balloon within the tube. The inner latex balloon is filled with dyed water, and the outer tube is filled with clear water. Two hemostats on either end of the phantom are occluding the posterior third of the latex tube to ensure that the balloon is in a more accurate anatomic position relative to the spinal cord. The hemostat at the distal end of the latex tube is used to maintain water pressure within the latex tube.
- FIG 3.
Fluoroscopic visualization of the phantom model shows the appearance of the model under fluoroscopy during a training session. The spinal needle can be seen within the C1–C2 space. The 2 screws seen in this image connect the skull base to the cervical spine and could not be removed in order to preserve integrity of the phantom.
- FIG 4.
Real example of a fluoroscopic image of a lateral C1–C2 spinal puncture that shows a lateral view of a C1–C2 spinal puncture performed on a patient for comparing the performance of the phantom in replicating fluoroscopic views during the procedure.
- FIG 5.
Stages of training of workshop participants. The graph shows the distribution of participant training levels during lateral C1–C2 spinal puncture training. A total of 21 individuals participated in training workshops, with 1 resident participating in 2 training workshops. PGY indicates postgraduate year; MS4, fourth-year medical student.
- FIG 6.
Pre- and postworkshop ratings of comfort, knowledge, and confidence of C1–C2 lateral cervical puncture. The image shows pre- and postsurvey results of participants’ ratings of their comfort performing, knowledge of steps, and anticipated success of lateral C1–C2 spinal puncture before and after taking part in an educational workshop using the cervical model developed in this article. Ratings were on a 5-point Likert scale.
Tables
Comparison of phantom performance in replicating actual lateral C1–C2 spinal punctures
Component of Phantom/Procedure Comparison with Real-Life Experience of Lateral C1–C2 Spinal Punctures Feel of alginate/soft tissue Similar Positioning of phantom/patient Different: The patient is usually positioned prone for this procedure, while the training simulated the patient being in the lateral decubitus position due to constraints of the fluoroscopy room available for training (not related to the phantom itself) Force required to penetrate outer latex tubing/dura Different: The amount of pressure required to pop through the outer latex tube dura was greater than in real life; this difference was emphasized to the trainees who participated Landmarks visualized under fluoroscopy Similar Speed of CSF egress Variable: depending on how much pressure we applied to outer latex tubing via a syringe and the PVC on/off valve; future directions include construction of a model with a pressure gauge so that we could fill the tubing to match normal CSF pressure (∼15 cm H20) Note:—PVC indicates polyvinyl chloride.
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