TissueDB/Simulators/Lumbar Laminectomy and Dural Closure Simulator (Bakhshi)

The Bakhshi spine surgery simulator (Figure 2). Part A: the foam-and-rexine book-fold block that opens like a book — the lower half holds the spine model and the upper half carries the incision slit. Part B: the opening widened with lumbar retractors, exposing the saw-bone spine. Part C: microscope views before and after laminectomy, with the latex-glove dura on a 5 cc syringe. Image by Bakhshi et al. (2022), BMC Medical Education 22:896, CC BY 4.0.

The Lumbar Laminectomy and Dural Closure Simulator (Bakhshi) is an in-house spine simulator for practising lumbar laminectomy and spinal dural closure. An L1–S1 saw-bone spine model sits inside a foam block covered with rexine that opens like a book. A slit in the upper component provides the operative opening. A latex glove mounted over a window in a 5 cc plastic syringe represents the dura beneath the laminectomy site. Trainees expose the spine with lumbar retractors, remove the lamina with a bone nibbler and Kerrison rongeur under an operating microscope, and practise closing the simulated dura with 6-0 Prolene.

Field	Details
Features and Basic Operation	The foam-and-rexine block opens like a book. Its lower component contains the saw-bone lumbar spine and its upper component has a slit representing the operative incision. Lumbar spine retractors widen the opening. The trainee performs laminectomy with a bone nibbler and Kerrison rongeur under an operating microscope, exposing a latex-glove dura that can then be sutured with 6-0 Prolene. The authors state that simulator difficulty can be increased by increasing depth.
Current Development Status	Used in a two-day national bootcamp (22 PGY-1 residents); laminectomy was assessed with mOSATS, dural closure was not evaluated, and the simulator is not yet validated on its own.
Estimated Build Time and Cost	US$60
Specialized Tools and Equipment	Bone nibbler and Kerrison rongeur for laminectomy; lumbar spine retractors for exposure; operating microscope for laminectomy and dural suturing. A 6-0 Prolene suture is used for dural closure. The source reports that the 6-0 Prolene was supplied free of charge by vendors during the bootcamp. The separate laminectomy instrument set cost US$42 per station.
Version	Version 2
Development Team Contact Information	Saqib Kamran Bakhshi, Medical College, Aga Khan University, Karachi, Pakistan; saqib.bakhshi@aku.edu. The simulator was used as part of the national neurosurgery bootcamp reported by Bakhshi et al. (2022).

Cost notes: The quoted total is for the spine simulator with saw-bone model. Build time was not reported. The laminectomy instrument set was reported separately at US$42 per set and is not included in the simulator cost.

Tissues

Tissue	Qty	Material	Cost	Notes
Bone	1 L1–S1 spine model	Saw-bone spine model	—	The source explicitly describes a saw-bone L1–S1 spine model used for laminectomy. The lamina is removed during the simulated procedure. The source does not identify a manufacturer or polymer composition for the saw-bone material.
Skin	1 access block	Foam covered with rexine	—	Bakhshi et al. describe two foam components covered with rexine that open like a book, with a slit in the upper component depicting the incision; the paper does not explicitly call this layer skin. The source does not state the block dimensions, exact foam type, joining method, or fixation method.
Dura Mater	1	Latex glove	—	The source explicitly states that a latex glove was used to simulate dura. It is pasted over a window in a 5 cc plastic syringe beneath the laminectomy site and is sutured with 6-0 Prolene under the microscope.

Structural Parts

Part Name	Qty	Material	Cost	Notes
Dura backing	1	Plastic syringe	—	The source describes a 5 cc plastic syringe with a window in its middle. The latex-glove dura is pasted over this window. The syringe supports and presents the simulated dura; it is not itself a tissue surrogate.

Consumables

Consumable	Quantity	Material	Approximate Cost	Notes
Dural-closure suture	As required	Polypropylene suture	-	Use-time consumable for suturing the simulated dura. The source reports that 6-0 Prolene sutures were provided free of charge by vendors during the bootcamp; this does not establish a normal purchase price.

Build Instructions

The construction information below is limited to what Bakhshi et al. (2022) explicitly describe or show for the spine simulator. The source does not provide a detailed fabrication protocol, dimensions for the foam block, or a complete bill of materials.

Phase 1: Prepare the operative-access block

Step 1: Prepare two foam components covered with rexine so that the assembly opens like a book.

Source limitation: the paper does not specify the dimensions of these components, the foam specification, how the rexine is attached, or how the two components are joined.

Step 2: Leave a space in the middle of the lower component for the lumbar spine model.

Step 3: Make a slit-like opening in the upper component to depict the operative incision.

Phase 2: Place the lumbar spine

Step 1: Position an L1–S1 saw-bone spine model in the central space in the lower component.

Source limitation: the paper does not specify a saw-bone manufacturer, polymer composition, or detailed fixation method for the spine model.

Phase 3: Prepare the simulated dura

Step 1: Make a window in the middle of a 5 cc plastic syringe.

Step 2: Paste latex-glove material over the syringe window to simulate the dura.

Step 3: Position the dura assembly beneath the intended laminectomy site.

Phase 4: Set up the laminectomy station

Step 1: Open the foam-and-rexine block.

Step 2: Apply lumbar spine retractors to widen the slit-like operative opening and improve exposure of the spine model.

Step 3: Position the simulator for use under the operating microscope.

Phase 5: Perform the simulated laminectomy

Step 1: Use a bone nibbler and Kerrison rongeur to remove the lamina from the saw-bone lumbar spine.

Step 2: Expose the latex-glove dura beneath the laminectomy site.

Evidence note: lumbar laminectomy was one of the four procedural skills formally assessed with mOSATS during the bootcamp. Residents performed each assessed skill at least three times, with the first and third attempts compared.

Phase 6: Practise spinal dural closure

Step 1: Use 6-0 Prolene under the operating microscope to suture the latex-glove dura.

Evidence limitation: simulated spinal dural closure was included as a bootcamp skill station and was rated for relevance and usefulness, but the authors explicitly state that the dural-closure task was not evaluated in the bootcamp.

Known limitations

• The source does not provide a complete step-by-step fabrication protocol for the simulator.
• The dimensions and detailed construction method of the foam-and-rexine block are not stated.
• The saw-bone manufacturer and material chemistry are not stated.
• The dural-closure task was not included in the formal procedural performance evaluation.
• The authors report that the simulator can be made more difficult by increasing operative depth.

See also

• Cranial Burr Hole and Craniotomy Simulator (Bakhshi) — cranial-access simulator from the same neurosurgery bootcamp family.