Clinical Report: Ergonomics and Musculoskeletal Disorders in Neurosurgical Practice

Overview

Work-related musculoskeletal disorders (WMSDs) are prevalent among neurosurgeons and spine surgeons, significantly impacting their quality of life and career longevity. This systematic review highlights the high prevalence of neck and back pain, repetitive strain injuries, and other musculoskeletal conditions related to surgical ergonomics, emphasizing the need for preventive interventions.

Background

Neurosurgeons, especially spine surgeons, frequently adopt sustained non-neutral postures during operations, such as prolonged neck flexion and leaning over the operating table, which predispose them to WMSDs. These disorders include a spectrum from mild discomfort to disabling injuries affecting muscles, tendons, nerves, and the skeletal system. The use of vibrating tools, repetitive hand movements, and heavy protective equipment further increase the risk of conditions like carpal tunnel syndrome and tendinitis. WMSDs can lead to time off work and may compromise surgical performance, yet ergonomics in neurosurgery remains underreported and insufficiently addressed.

Data Highlights

Twelve studies were included in the final analysis, with six focusing on spine surgery ergonomics and five on cranio-facial surgery, mainly endoscopic. The studies varied in design, including surveys, cross-sectional studies, and technical notes. Due to heterogeneity in study parameters and outcomes, quantitative meta-analysis was not feasible. The review identified a significant prevalence of neck and back pain among spine surgeons and highlighted the ergonomic challenges unique to different neurosurgical subspecialties.

Key Findings

• Spine neurosurgeons commonly experience neck and back pain due to prolonged non-neutral postures during surgery.
• Repetitive use of vibrating power tools and heavy lead aprons contributes to repetitive strain injuries and carpal tunnel syndrome.
• WMSDs encompass a range of conditions including tendinitis, degenerative spine diseases, thoracic outlet syndrome, and tension neck syndrome.
• Musculoskeletal disorders can lead to reduced work capacity and negatively affect surgical performance and career longevity.
• Ergonomics in neurosurgery is underreported and lacks formal attention during neurosurgical training.
• Preventive interventions focusing on postural ergonomics are necessary but currently insufficiently implemented.

Clinical Implications

Clinicians and hospital administrations should prioritize ergonomic assessments and interventions to reduce the burden of WMSDs among neurosurgeons. Incorporating ergonomic training during residency and adopting surgical techniques and equipment that minimize non-neutral postures may improve surgeons' quality of life and career sustainability. Awareness and preventive strategies could reduce time off work and maintain surgical performance.

Conclusion

WMSDs represent a significant occupational hazard for neurosurgeons, particularly spine surgeons, due to the physical demands of their work. Addressing ergonomic challenges through targeted interventions and education is essential to enhance surgeon well-being and professional longevity.

References

1. World Health Organization -- Definition of Work-Related Musculoskeletal Disorders
2. Health and Safety Executive UK -- Musculoskeletal Disorders Statistics 2019
3. Hozo et al. 2005 -- Estimating Mean and Standard Deviation from Median and Range
4. Newcastle–Ottawa Quality Assessment Scale -- Quality Assessment of Non-Randomized Studies
5. Oxford Centre for Evidence-Based Medicine -- Levels of Evidence