Ergonomics in Spine Surgery

Abstract

As physician burnout and wellness become increasingly recognized as vital themes for the medical community to address, the topic of chronic work-related conditions in surgeons must be further evaluated. While improving ergonomics and occupational health have been long emphasized in the executive and business worlds, particularly in relation to company morale and productivity, information within the surgical community remains relatively scarce. Chronic peripheral nerve compression syndromes, hand osteoarthritis, cervicalgia and back pain, as well as other repetitive musculoskeletal ailments affect many spinal surgeons. The use of ergonomic training programs, an operating microscope or exoscope, powered instruments for pedicle screw placement, pneumatic Kerrison punches and ultrasonic osteotomes, as well as utilizing multiple surgeons or microbreaks for larger cases comprise several methods by which spinal surgeons can potentially improve workspace health. As such, it is worthwhile exploring these areas to potentially improve operating room ergonomics and overall surgeon longevity.

Spine Surgeon Health and Well-being

“…The high rate of neck pain among spine surgeons makes intuitive sense, as hyperflexion of the neck to obtain downward gaze and proper visualization is often maintained during surgery, with a 30-degree flexion of the neck resulting in 4 times increase in weight on the cervical spine and 60 degrees of flexion resulting in a head weight of 60 lb. 18,19 This is further exacerbated by the excess weight of loupes and headlights often utilized by spine surgeons. Kothari and Urakov 20 reported on the kyphotic nature of spine surgery to the operative surgeon, with 41.6% of time during surgery being spent slouching.…”

Beyond Magnification and Illumination: Ergonomics with a 3D Exoscope in Lumbar Spine Microsurgery to Reduce Musculoskeletal Injuries

“…Some articles provide suggestions for protecting MSI by correcting education in OR ergonomics and monitoring specific self-therapy exercises for individual musculoskeletal assets. 4,5 Additionally, in some literature, it is advised to reduce MSI, including the use of ergonomic equipment such as an exoscope and proper ergonomic positioning for the medical service provider, not just taking analgesics to relieve MSI symptoms. 43,44 Strengths and Limitations This study systematically compares exoscope with OM in terms of unique advantages and limitations in lumbar surgeries.…”

“…3 Work-related injuries are common among surgeons, with 47% to 87% reporting symptoms of musculoskeletal pain due to their surgical practice. 4,5 Musculoskeletal symptoms associated with surgery can manifest in a variety of ways, with the most frequently affected regions being the neck (79%), lower back (75%), upper back (59%), shoulders (51%), wrist, and hand (26%). 6 The risk of musculoskeletal injuries (MSIs) increases over years of practice which may lead to career-ending among surgeons.…”

Ergonomics in Otolaryngologic Surgery: A State of the Art Review

“…2 Other surgical specialties have been known to experience issues with ergonomics in the operating room for decades. [5][6][7][8] Similarly, poor ergonomics in the office workplace has been well documented to cause a variety of workrelated musculoskeletal disorders (WRMDs). 9,10 While there have been studies done investigating interventions that decrease ergonomic strain in the workplace and other surgical specialties, there is currently little research analyzing how ergonomic risk can be mitigated in the field of otolaryngology.…”

“…Importantly, ergonomic risk is a frequently overlooked and untaught concept leading to unawareness of ergonomic principles, not only in all surgical specialties, but also in other professions 2 . Other surgical specialties have been known to experience issues with ergonomics in the operating room for decades 5‐8 . Similarly, poor ergonomics in the office workplace has been well documented to cause a variety of work‐related musculoskeletal disorders (WRMDs) 9,10 …”