[Analysis of spinal stress during surgery in otolaryngology]

Work-related musculoskeletal symptoms in otorhinolaryngology and their relationship with physical activity. A nationwide survey

OBJECTIVE

The main objective of this study was to determine the prevalence of work-related musculoskeletal symptoms in otolaryngology and head and neck surgery specialists and trainees in Spain, and to measure the effect that physical exercise could have on muscular discomfort.

METHOD

A cross-sectional survey was administered between September and December 2017 to practising otolaryngologists.

RESULTS

Four hundred and three ENT surgeons responded, with a median age of 44.9 years, and 89.8 per cent reported discomfort or physical symptoms that they attributed to surgical practice. More female surgeons reported musculoskeletal symptoms (92.8 per cent vs 87.1 per cent; p = 0.04). When the level of physical activity was compared with the frequency of physical discomfort, no significant difference was found.

CONCLUSION

This study has shown a high prevalence of musculoskeletal disorders among ENT surgeons in Spain but has failed to demonstrate an important role of physical exercise in the prevention of musculoskeletal disorders.

An overview of occupational hazards amongst UK Otolaryngologists

Occupational-related hazards (OH) are noted to be prevalent within the medical community. However, there is limited evidence of its effects amongst ENT surgeons. A national survey was carried out with the assistance of ENT-UK to investigate the prevalence of various OH amongst ENT doctors in the UK. A literature search was also conducted to search for articles within English literature worldwide on this subject. 70.6 % of the responding 323 ENT surgeons had reported a form of OH throughout their career. Musculoskeletal pain was the most commonly reported (47.4 %) followed by stress/psychiatric morbidities (38.4 %) and sharps injuries (26.6 %). We found no correlation between OH and consultants/non-consultant status, time spent in ENT and subspecialty. Our literature search revealed 16 articles pertaining to OH amongst ENT doctors. OHs are prevalent within the UK ENT community. There is good evidence within literature on musculoskeletal pain, however, higher level studies are required to thoroughly investigate the other hazards.

Prevalence and risk factors for musculoskeletal problems associated with microlaryngeal surgery: a national survey

OBJECTIVES/HYPOTHESIS

Microlaryngeal surgery (MLS) presents ergonomic challenges to surgeons and potential risks for developing musculoskeletal symptoms (MSSx). This study describes prevalence and risk factors of MLS-associated MSSx.

STUDY DESIGN

Cross-sectional survey.

METHODS

A questionnaire was administered to members of the American Academy of Otolaryngology-Head and Neck Surgery. Outcome measures related to surgeon demographics, training, MLS experience, operating room setup, experience of MSSx in relation to MLS, treatment sought, and practice changes due to MSSx.

RESULTS

Response rate was 9.2% (n = 476); 83% reported musculoskeletal symptoms during MLS, and 21% reported rest breaks during MLS. Taking breaks was independently associated with back support lack (odds ratio [OR] = 2.08) and surgery lasting >30 minutes (OR = 1.68). Areas most commonly affected were neck, upper back, shoulder, and lower back. Ten percent reported treatment for MLS-related MSSx. Some respondents reported major practice changes due to MSSx, including fewer cases, ceasing to perform MLS, applying for disability, and early retirement.

CONCLUSIONS

Musculoskeletal symptoms are common (83%) among surgeons performing microlaryngeal surgery. Findings suggest multiple factors may contribute to development of MSSx in otolaryngologists. Risk factors for MSSx and taking breaks during surgery include average case operating time >30 minutes and absence of back support. Previous studies have identified neck flexion and lack of arm support as associated with risk of musculoskeletal injury. This study demonstrates that MSSx related to surgery do occur in otolaryngologists, and that poor surgical ergonomics may play a role. Surgeons should consider proper support and positioning during MLS to protect their health.

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

PURPOSE

Surgeon spine angle during surgery was studied ergonomically and the kinematics of the surgeon's spine was related with musculoskeletal fatigue and pain. Spine angles varied depending on operation table height and visualization method, and in a previous paper we showed that the use of a loupe and a table height at the midpoint between the umbilicus and the sternum are optimal for reducing musculoskeletal loading. However, no studies have previously included a microscope as a possible visualization method. The objective of this study is to assess differences in surgeon spine angles depending on operating table height and visualization method, including microscope.

MATERIALS AND METHODS

We enrolled 18 experienced spine surgeons for this study, who each performed a discectomy using a spine surgery simulator. Three different methods were used to visualize the surgical field (naked eye, loupe, microscope) and three different operating table heights (anterior superior iliac spine, umbilicus, the midpoint between the umbilicus and the sternum) were studied. Whole spine angles were compared for three different views during the discectomy simulation: midline, ipsilateral, and contralateral. A 16-camera optoelectronic motion analysis system was used, and 16 markers were placed from the head to the pelvis. Lumbar lordosis, thoracic kyphosis, cervical lordosis, and occipital angle were compared between the different operating table heights and visualization methods as well as a natural standing position.

RESULTS

Whole spine angles differed significantly depending on visualization method. All parameters were closer to natural standing values when discectomy was performed with a microscope, and there were no differences between the naked eye and the loupe. Whole spine angles were also found to differ from the natural standing position depending on operating table height, and became closer to natural standing position values as the operating table height increased, independent of the visualization method. When using a microscope, lumbar lordosis, thoracic kyphosis, and cervical lordosis showed no differences according to table heights above the umbilicus.

CONCLUSION

This study suggests that the use of a microscope and a table height above the umbilicus are optimal for reducing surgeon musculoskeletal fatigue.

A new approach to assess movements and isometric postures of spine and trunk at the workplace

Low back pain is regarded as the primary cause of occupational disability in many countries worldwide. However, there is a lack of valid assessment of kinematic spine and trunk parameters to provide further insight into occupational spine loads. A new 3-dimensional mobile measurement system (3D-SpineMoveGuard) was developed and evaluated by means of repeated dynamic and isometric trunk positions by 10 male and 10 female volunteers. The interclass correlation coefficient indicates high test-retest reliability (r = 0.975-0.999) of the 3D-SpineMoveGuard. Moreover, analysis of validity revealed almost identical results for the new measurement system. The evaluation study indicates a good scientific quality for the use in occupational task analyses. The objective assessment of indirectly measured spine and trunk kinematics will give further insight to predict and prevent job-related spine loads.