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Spine surgeon's kinematics during discectomy, part II: operating table height and visualization methods, including

Jeong Yoon Park1, Kyung Hyun Kim, Sung Uk Kuh

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Summary

Using a microscope and a higher operating table reduces surgeon spine strain. Optimal ergonomics for spine surgery involve microscope visualization and a table height above the umbilicus to minimize musculoskeletal fatigue.

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Area of Science:

  • Ergonomics in surgery
  • Musculoskeletal health in surgical professionals
  • Spine surgery biomechanics

Background:

  • Surgeon posture and spine angles are critical for preventing musculoskeletal fatigue and pain during surgical procedures.
  • Previous research identified optimal operating table height and loupe magnification for reducing strain, but did not include microscopes.
  • Microscopes are increasingly used in spine surgery, necessitating an ergonomic evaluation of their impact on surgeon posture.

Purpose of the Study:

  • To assess how different operating table heights and visualization methods (naked eye, loupe, microscope) affect surgeon spine angles.
  • To determine the ergonomic implications of microscope use in spine surgery compared to traditional methods.
  • To identify optimal ergonomic setups for minimizing musculoskeletal loading in spine surgeons.

Main Methods:

  • Eighteen experienced spine surgeons participated in a discectomy simulation using a spine surgery simulator.
  • Surgeons utilized three visualization methods: naked eye, loupe, and microscope.
  • Three operating table heights were tested: anterior superior iliac spine, umbilicus, and midpoint between umbilicus and sternum.
  • A 16-camera optoelectronic motion analysis system captured whole spine angles, including lumbar lordosis, thoracic kyphosis, and cervical lordosis.

Main Results:

  • Significant differences in whole spine angles were observed based on the visualization method used.
  • Microscope use resulted in spine angles closer to natural standing values compared to naked eye or loupe.
  • Increasing operating table height brought spine angles closer to natural standing values, irrespective of visualization method.
  • With microscope use, lumbar, thoracic, and cervical lordosis showed no significant changes at table heights above the umbilicus.

Conclusions:

  • The use of a microscope in spine surgery is ergonomically advantageous, promoting more natural spine alignment.
  • Operating table heights set above the umbilicus are recommended for reducing musculoskeletal strain.
  • Combining microscope visualization with a higher operating table offers an optimal ergonomic setup to minimize surgeon fatigue.