Virtual Reality Anterior Cervical Discectomy and Fusion Simulation on the Novel Sim-Ortho Platform: Validation Studies

Nicole Ledwos, Nykan Mirchi, Vincent Bissonette, Alexander Winkler-Schwartz, Recai Yilmaz, Rolando Del Maestro

DOI: 10.1093/ons/opaa269



Virtual reality spine simulators are emerging as potential educational tools to assess and train surgical procedures in safe environments. Analysis of validity is important in determining the educational utility of these systems.


To assess face, content, and construct validity of a C4-C5 anterior cervical discectomy and fusion simulation on the Sim-Ortho virtual reality platform, developed by OSSimTechTM (Montreal, Canada) and the AO Foundation (Davos, Switzerland).


Spine surgeons, spine fellows, along with neurosurgical and orthopedic residents, performed a simulated C4-C5 anterior cervical discectomy and fusion on the Sim-Ortho system. Participants were separated into 3 categories: post-residents (spine surgeons and spine fellows), senior residents, and junior residents. A Likert scale was used to assess face and content validity. Construct validity was evaluated by investigating differences between the 3 groups on metrics derived from simulator data. The Kruskal-Wallis test was employed to compare groups and a post-hoc Dunn’s test with a Bonferroni correction was utilized to investigate differences between groups on significant metrics.


A total of 21 individuals were included: 9 post-residents, 5 senior residents, and 7 junior residents. The post-resident group rated face and content validity, median ≥4, for the overall procedure and at least 1 tool in each of the 4 steps. Significant differences (P < .05) were found between the post-resident group and senior and/or junior residents on at least 1 metric for each component of the simulation.


The C4-C5 anterior cervical discectomy and fusion simulation on the Sim-Ortho platform demonstrated face, content, and construct validity suggesting its utility as a formative educational tool.