Abstract:

This paper presents:
1) development of 3D printed models of a vertebral compression fracture of lumbar spine segment L1 that resulted from a patient with low bone density,
2) description of kyphoplasty procedure to repair the compression fracture and
3) integrate these 3D printed models and 3D computer models into the simulation based learning experience (SBLE) for nursing students.

An elderly patient was diagnosed with a compression fracture of lumbar spine segment L1. An MRI was initially made of L1 fracture. Kyphoplasty was performed by a surgeon to repair the compression fracture to address curvature of the spine and to restore some height. Shortly thereafter patient suffered a fracture of the thoracic spine segment T12 which is the vertebra just above L1. A second MRI was made and followed by a kyphoplasty procedure.
Two MRI files were obtained for the patient with the compression fracture of L1 and later compression fracture of T12. Fortunately the second MRI also showed the results of the kyphoplasty procedure of L1. Consequently, it was possible to 3D printed models of the before and after kyphoplasty. Throughout the process faculty was actively involved and closely monitored the development process and provided guidance for model development.

SBLE occur in a simulation laboratory where nursing students come for a given time to engage in specifically designed realistic patient scenarios around a set of learning objectives. A simulation scenario contains learning objectives, performance measures, patient’s clinical information (background, current condition, medications and other information), actor scripts as needed, timeline for unfolding of the scenario, cues needed by the facilitator to progress the learner’s actions and other information to ensure that SBLE is robust, immersive and successful.

The College has developed over 130 SBLEs. Each simulated clinical experience is documented and placed in a 3-ring binder with specific objectives, a detailed set up sheet and pictures for standardized repetition with multiple clinical groups. Once a training simulation scenario has been selected the patient ‘room’ is simulated, configured and manikin is programmed for the initial patient conditions for simulation. Control room and patient examining room are set-up to run the scenario.

The 3D printed models of compression fracture of L1 before and after the kyphoplasy procedure are being integrated into the SBLE used during anatomy and physiology classes prior to the experience or in simulation briefings to increase comprehension of the injury and surgical procedure. 3Dbuilder computer models are of significant value to the students in visualizing the models in 3D and especially in the ability of rotating and enlarging specific areas of the vertebra for more detailed evaluation.

This paper presents a discussion of osteopenia, the segments of vertebrae in the spine segments, the steps in converting MRIs into STL files, several spine segments from the literature with compression fractures, the 3Dbuilder computer models, the 3D printing of the models, a description of several of the simulation based experiences, the integration of the models into the SBLEs for nursing students and conclusions.