Spine Surgeon's Kinematics during Discectomy, Part II: Operating Table Height and Visualization Methods, Including Microscope
Authors: Park J. Y. , Kuh S. U. , Cho Y. E. 
Published: May 2014

Introduction

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. Disclosure of Interest J. Y. Park: Conflict with Technology Innovation Program (10040097) funded by the Ministry of Trade, Industry and Energy, Republic of Korea (MOTIE, Korea) S. U. Kuh: None declared Y. E. Cho: Conflict with Technology Innovation Program (10040097) funded by the Ministry of Trade, Industry and Energy, Republic of Korea (MOTIE, Korea) References Wunderlich M, Jacob R, Stelzig Y, Rüther T, Leyk D. [Analysis of spinal stress during surgery in otolaryngology]. HNO 2010;58(8):791–798 Park JY, Kim KH, Kuh SU, Chin DK, Kim KS, Cho YE. Spine surgeon's kinematics during discectomy according to operating table height and the methods to visualize the surgical field. Eur Spine J 2012;21(12):2704–2712 van Det MJ, Meijerink WJ, Hoff C, Totté ER, Pierie JP. Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines. Surg Endosc 2009;23(6):1279–1285 Kant IJ, de Jong LC, van Rijssen-Moll M, Borm PJ. A survey of static and dynamic work postures of operating room staff. Int Arch Occup Environ Health 1992;63(6):423–428 Shirzadi A, Mukherjee D, Drazin DG, et al. Use of the video telescope operating monitor (VITOM) as an alternative to the operating microscope in spine surgery. Spine 2012;37(24):E1517-E1523 Postacchini F, Postacchini R. Operative management of lumbar disc herniation : the evolution of knowledge and surgical techniques in the last century. Acta Neurochir Suppl (Wien) 2011;108:17–21 Kranenburg G, Gossot. Ergonomic problems encountered during video-assisted thoracic surgery. Minim Invasive Ther Allied Technol 2004;13(3):147–155 Lee G, Lee T, Dexter D, et al. Ergonomic risk associated with assisting in minimally invasive surgery. Surg Endosc 2009;23(1):182–188 Mirbod SM, Yoshida H, Miyamoto K, Miyashita K, Inaba R, Iwata H. Subjective complaints in orthopedists and general surgeons. Int Arch Occup Environ Health 1995;67(3):179–186 Cenic A, Kachur E. Lumbar discectomy: a national survey of neurosurgeons and literature review. Can J Neurol Sci 2009;36(2):196–200 Branson BG, Bray KK, Gadbury-Amyot C, et al. Effect of magnification lenses on student operator posture. J Dent Educ 2004;68(3):384–389 Mamoun JS. A rationale for the use of high-powered magnification or microscopes in general dentistry. Gen Dent 2009;57(1):18-26, quiz 27-28, 95–96 Maggio MP, Villegas H, Blatz MB. The effect of magnification loupes on the performance of preclinical dental students. Quintessence Int 2011;42(1):45–55 Chang BJ. Ergonomic benefits of surgical telescope systems: selection guidelines. J Calif Dent Assoc 2002;30(2):161–169 Berquer R, Smith WD, Davis S. An ergonomic study of the optimum operating table height for laparoscopic surgery. Surg Endosc 2002;16(3):416–421 van Veelen MA, Kazemier G, Koopman J, Goossens RH, Meijer DW. Assessment of the ergonomically optimal operating surface height for laparoscopic surgery. J Laparoendosc Adv Surg Tech A 2002;12(1):47–52