Epidemiology of Work-Related Neck Pain Among Spine Surgeons

Comparison of clinical efficacy and surgeon's neck flexion time between unilateral biportal endoscopic lumbar fusion versus minimally invasive transforaminal lumbar fusion in the treatment of single-level lumbar degenerative diseases: a single center retrospective study

PURPOSE

This retrospective study aimed to evaluate the clinical efficacy and surgeon's neck flexion time between unilateral biportal endoscopic lumbar fusion (UBE-LIF) versus minimally invasive transforaminal lumbar fusion (MIS-TLIF) in the treatment of single-level lumbar degenerative diseases (LDD).

METHODS

This study retrospectively enrolled patients with single-level LDD received UBE-LIF or MIS-TLIF between June 2018 to May 2022. The patients were separated into two groups based on the surgical method used: the UBE-LIF group (n = 38) and the MIS-TLIF group (n = 42). Various parameters, including operative time, fluoroscopy frequency, blood loss, length of hospital stay, total expenses, visual analogue scale (VAS), and Oswestry Disability Index (ODI), modified MacNab criteria, fusion rate, and complications were evaluated and compared between the two groups. And time for neck flexion during surgery by the surgeon were recorded. After the surgery, surgeons completed a questionnaire based on a visual analog scale to assess their discomfort symptoms of the neck, shoulders, and back.

RESULTS

There were no significant differences in VAS or ODI scores at 12 months after surgery among two groups. However, the UBE-LIF group had significantly better VAS scores for low back pain on the first day after surgery than the MIS-TLIF group(2.00 ± 0.70) (2.55 ± 0.94) (P < 0.05). Additionally, the UBE-LIF group had shorter intraoperative bleeding (78.42 ± 51.440) ml (169.29 ± 52.656) ml (P < 0.05). There were no significant differences in fluoroscopy frequency and incidence of complications among two groups. But total expenses in the UBE-LIF group (73246 ± 4354) yuan were significantly higher than those in the MIS-TLIF group (60577 ± 4160) yuan (P < 0.05). In the UBE-LIF group, the surgeon's neck flexion time was significantly reduced(52.00 ± 18.233) min (102.83 ± 11.77) min (P < 0.05), and there was a statistically significant reduction in the visual analog scale discomfort scores for the neck, back, and shoulders (P < 0.05).

CONCLUSIONS

Both UBE-LIF and MIS-TLIF can achieve good postoperative results. UBE has less intraoperative bleeding, less postoperative drainage flow, lower postoperative patient low back pain score, and slightly higher cost than MIS-TLIF. However, the surgeon has a shorter time to lower their head during surgery and higher comfort during surgery.

Advanced Visualization in Minimally Invasive Spine Surgery: The Ergonomics, Economics, and Evolution of Camera-Based Tubes and Retractors

BACKGROUND

Tubular spine surgery has emerged as a hallmark of minimally invasive spine (MIS) procedures. In recent years, thanks to technological advances, tubular dilators and retractors have been integrated with digital cameras to allow for ergonomic, high-definition visualization of the surgical field.

OBJECTIVE

To detail the evolution, ergonomics, economics, and outcomes of camera-based tubular spine surgery, spanning the origins of MIS tubular techniques to the current use of operative microscopes and tube-mounted digital cameras (TMDCs).

METHODS

This is a narrative review of studies examining the evolution of tubular spine surgery as well as its most recent advances, with a particular emphasis on advances in visualization of the surgical field.

RESULTS

Despite early resistance to tubular techniques due to a steep learning curve, minimally invasive tubular approaches are being increasingly adopted by the mainstream spine surgical community, which has resulted in an expansion of both indications and procedural modalities. This can largely be attributed to the increased quality of visualization, as evidenced by improvements in microscopes as well as emerging technologies like exoscopes and TMDCs. Tubular MIS procedures have also achieved superior efficacy compared with open surgical approaches for the treatment of several spinal pathologies while allowing for improved ergonomics, which may have lasting consequences on surgeon longevity.

CONCLUSIONS

Advances in visualization technologies have allowed tubular surgery to become an effective, ergonomic, and muscle-sparing alternative to open spine surgery. Further research is necessary to quantify the true costs and outcomes associated with nascent TMDC technology.

CLINICAL RELEVANCE

This work elucidates developments in visualization for tubular spine surgery.

LEVEL OF EVIDENCE: 5

Ergonomics in Spine Surgery: A Systematic Review

STUDY DESIGN

This study is a systematic review.

OBJECTIVE

This systematic review aims to synthesize existing studies and highlight the significance of ergonomic considerations for spine surgeons' well-being and the impact on patient outcomes.

SUMMARY OF BACKGROUND DATA

Spine surgery is a physically demanding field that poses several risks to surgeons, particularly with musculoskeletal disorders. Despite the well-documented consequences of musculoskeletal injuries endured by surgeons, surgical ergonomics in spine surgery has received limited attention.

METHODS

Following PRISMA guidelines, a comprehensive literature search was conducted in PubMed and Embase. Studies focusing on surgeon ergonomics in spine surgery were selected. Data extracted included study details, surgeon demographics, ergonomic factors, and outcomes. Qualitative analysis was performed due to the heterogeneous nature of study designs and criteria.

RESULTS

Eleven studies met the inclusion criteria. Six studies utilized surveys to explore physical challenges, prevalence rates of pain, work practices, and ergonomic tools. Two studies employed optoelectronic motion analysis to assess the spinal angles of the surgeon during surgery. Two studies assesed ergonomics in different visualization methods using rapid entire body assessment (REBA). One study applied video analysis to scrutinize surgeons' neck postures during the case. The results demonstrated a varying prevalence and diverse presentations of musculoskeletal disorders, varying impact on surgical performance, and nuanced relationships between experience, workload, and ergonomic concerns.

CONCLUSION

This systematic review summarizes the heterogeneous evaluations of ergonomics in spine surgery. Overall, upwards of three-quarters of spine surgeons have reported musculoskeletal discomfort, most commonly presented as back pain, neck pain, and hand/wrist discomfort. These symptoms are often exacerbated by the use of loupes, operating bed height, and extended periods of time in various positions. Studies demonstrate that physical discomfort is associated with the surgeons' mental and emotional well-being, leading to stress, burnout, and reduced job satisfaction, all of which impact patient care.

Biomechanical and ergonomic risks associated with cervical musculoskeletal dysfunction amongst surgeons: A systematic review

INTRODUCTION

Surgeons are at high risk of developing musculoskeletal symptoms due to a range of factors including, maladaptive positioning and surgical ergonomics. Cervical muscle strain and biomechanical load is most prevalent due to repetitive motions and prolonged static neck positioning. This issue is apparent through reports of prevalence between 10 and 74.4% among surgeons. The aim of this systematic review is to provide an objective assessment of the clinical evidence available and a descriptive analysis of the effects of kinematics and surgical ergonomics on the prevalence of surgeons' cervical musculoskeletal pain.

METHODS

This is PRISMA-compliant systematic review of clinical studies assessing the prevalence of cervical musculoskeletal dysfunction in surgeons by searching PUBMED and Ovid EMBASE databases from inception to 19th October 2023. Study quality was graded according to the National Institutes of Health study quality assessment tools.

RESULTS

A total of 9 studies were included in the final qualitative analysis. The use of loupes, open surgery and excessive neck flexion (>30°) were associated with cervical dysfunction. Comparison of study outcomes was challenging due to heterogeneity within study methods and the paucity of methodological quality.

CONCLUSION

The current literature assessing ergonomic and biomechanical factors predisposing surgeons to cervical musculoskeletal dysfunction is insufficient to provide reliable guidance for clinicians. Although the literature identifies factors contributing to work-related cervical dysfunction, few attempt to evaluate interventions for improved surgical ergonomics. An objective assessment of interventions that prompt postural correction with the aim to improve neck pain in surgeon cohorts is warranted.