title: Spine surgeon's kinematics during discectomy, part II: operating table height and visualization methods, including microscope.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  This study suggests that the use of a microscope and a table height above the umbilicus are optimal for reducing surgeon musculoskeletal fatigue.
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, The Spine and Spinal Cord Institute, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, South Korea.
authors.forename: Jeong Yoon
authors.initials: JY
authors.lastname: Park
authors.forename: Kyung Hyun
authors.initials: KH
authors.lastname: Kim
authors.forename: Sung Uk
authors.initials: SU
authors.lastname: Kuh
authors.forename: Dong Kyu
authors.initials: DK
authors.lastname: Chin
authors.forename: Keun Su
authors.initials: KS
authors.lastname: Kim
authors.forename: Yong Eun
authors.initials: YE
authors.lastname: Cho
mesh_terms: D001696:Biomechanical Phenomena; D017586:Diskectomy / Q000379:methods*; D006801:Humans; D008141:Lordosis / Q000601:surgery; D008954:Models, Biological; D058638:Operating Tables / Q000592:standards*; D066231:Surgeons / Q000706:statistics & numerical data*