TissueDB/Simulators/Lumbar Laminectomy and Dural Closure Simulator (Bakhshi)
The Lumbar Laminectomy and Dural Closure Simulator (Bakhshi) is an in-house spine simulator for practising lumbar laminectomy and spinal dural closure.[1] 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 | Built in-house and used during a two-day national neurosurgery bootcamp attended by 22 PGY-1 residents. Lumbar laminectomy was one of four procedural skills evaluated with the modified Objective Structured Assessment of Technical Skills (mOSATS), comparing first and third attempts. Simulated spinal dural closure was included in the curriculum and received separate relevance and usefulness ratings, but the authors state that the dural-closure task itself was not evaluated in the bootcamp. The spine simulator has not been systematically validated as a standalone training simulator. |
| Estimated Build Time and Cost | - US$60 for the spine simulator with saw-bone model. The laminectomy instrument set was reported separately at US$42 per set and is not included in the simulator cost. |
| 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 1 |
| 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). |
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 | - | Canonical TissueDB editorial mapping for the external operative-access layer. 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 | 5 cc 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 | 6-0 Prolene 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. Do not infer those details.
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. Do not transfer the laminectomy mOSATS findings to dural closure.
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
[edit | edit source]- Cranial Burr Hole and Craniotomy Simulator (Bakhshi) — cranial-access simulator from the same neurosurgery bootcamp family.
| Authors | Arturopelayo |
|---|---|
| License | CC-BY-SA-4.0 |
| Cite as | Arturopelayo (2026). "TissueDB/Simulators/Lumbar Laminectomy and Dural Closure Simulator (Bakhshi)". Appropedia. Retrieved September 28, 2026. |
- ↑ Bakhshi SK, Ahmad R, Merchant AAH, Noorali AA, Abdul Rahim K, Shaikh NQ, Afzal N, Lakhdir MPA, Shamim MS, Haider AH. "Development, outcome and costs of a simulation-based neurosurgery bootcamp at the national level." BMC Medical Education. 2022;22:896. DOI: 10.1186/s12909-022-03965-9. PMID: 36578075. PMC: PMC9795592. CC BY 4.0.