Abstract
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.
Similar content being viewed by others
References
Wunderlich M, Jacob R, Stelzig Y, Rüther T, Leyk D (2010) Analysis of spinal stress during surgery in otolaryngology. HNO 58:791–798
Park JY, Kim KH, Kuh SU, Chin DK, Cho YE (2012) Spine surgeon’s kinematics during discectomy according to operating table height and the methods to visualize the surgical field. Eur Spine J 21:2704–2712
van Det MJ, Meijerink WJ, Hoff C, Tott ER, Pierie JP (2009) Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines. Surg Endosc 23:1279–1285
Kant IJ, de Jong LC, van Rijssen-Moll M, Borm PJ (1992) A survey of static and dynamic work postures of operating room staff. Int Arch Occup Environ Health 63:423–428
Shirzadi A, Mukherjee D, Drazin DG, Paff M, Perri B, Mamelak AN, Siddique K (2012) Use of the video telescope operating monitor (VITOM) as an alternative to the operating microscope in spine surgery. Spine 37:1517–1523
Postacchini F, Postacchini R (2011) Operative management of lumbar disc herniation: the evolution of knowledge and surgical techniques in the last century. Acta Neurochir Suppl 108:17–21
Kranenburg Gossot (2004) Ergonomic problems encountered during video-assisted thoracic surgery. Minim Invasive Ther Allied Technol 13:147–155
Lee G, Lee T, Dexter D, Godinez C, Meenaghan N, Catania R, Park A (2009) Ergonomic risk associated with assisting in minimally invasive surgery. Surg Endosc 23:182–188
Mirbod SM, Yoshida H, Miyamoto K, Miyashita K, Inaba R, Iwata H (1995) Subjective complaints in orthopedists and general surgeons. Int Arch Occup Environ Health 67:179–186
Cenic A, Kachur E (2009) Lumbar discectomy: a national survey of neurosurgeons and literature review. Can J Neurol Sci 36:196–200
Branson BG, Bray KK, Gadbury Amyot C, Holt LA, Keselyak NT, Mitchell TV, Williams KB (2004) Effect of magnification lenses on student operator posture. J Dent Educ 68:384–389
Mamoun JS (2009) A rationale for the use of high-powered magnification or microscopes in general dentistry. Gen Dent 57:18–26
Maggio MP, Villegas H, Blatz MB (2011) The effect of magnification loupes on the performance of preclinical dental students. Quintessence Int 42:45–55
Chang BJ (2002) Ergonomic benefits of surgical telescope systems: selection guidelines. J Calif Dent Assoc 30:161–169
Berquer R, Smith WD, Davis S (2002) An ergonomic study of the optimum operating table height for laparoscopic surgery. Surg Endosc 16:416–421
van Veelen MA, Kazemier G, Koopman J, Goossens RH, Meijer DW (2002) Assessment of the ergonomically optimal operating surface height for laparoscopic surgery. J Laparoendosc Adv Surg Tech A 12:47–52
Acknowledgments
This work is supported by the Technology Innovation Program (10040097) funded by the Ministry of Trade, Industry and Energy Republic of Korea (MOTIE, Korea).
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Park, J.Y., Kim, K.H., Kuh, S.U. et al. Spine surgeon’s kinematics during discectomy, part II: Operating table height and visualization methods, including microscope. Eur Spine J 23, 1067–1076 (2014). https://doi.org/10.1007/s00586-013-3125-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-013-3125-6