Virtual reality surgical simulator training of residents and early-career surgeons for pedicle screw placement: a systematic review and meta-analysis

To evaluate the effectiveness of Virtual reality (VR) simulation training compared with traditional teaching methods for residents and early-career surgeons training in pedicle screw insertion.

PubMed, Embase, and the Cochrane Library were systematically searched from inception to December 2025. Randomized controlled trials (RCTs) comparing VR simulator training with traditional training approaches for pedicle screw placement in residents and early-career surgeons were included. A random-effects model was applied to pool outcomes, with treatment effects expressed as mean differences or risk ratios with 95% confidence intervals.

A total of six RCTs were included, with 54 trainees and 457 screws inserted in each study group. Pooled analyses demonstrated that residents and early-career surgeons trained with VR simulation achieved a significantly higher rate of optimal (Grade I) pedicle screw placement than those receiving conventional training (RR 1.36; 95% CI 1.15 to 1.61). Conversely, VR training was associated with significantly lower rates of Grade II (RR 0.61; 95% CI 0.45 to 0.85), Grade III (RR 0.07; 95% CI 0.02 to 0.30), and Grade IV screw placements (RR 0.16; 95% CI 0.03 to 0.90), indicating consistent reductions across all severities of cortical breach. Overall procedural success was significantly higher in the VR group (RR 1.17; 95% CI 1.04 to 1.32). Furthermore, VR-trained residents and early-career surgeons demonstrated shorter screw penetration distances and fewer displaced screws per resident.