Neck Postures and Cervical Spine Loading Among Microsurgeons Operating with Loupes and Headlamp

Abstract

OCCUPATIONAL APPLICATIONS Surgical tasks performed using loupes and headlamps were examined to identify exposures to physical risk factors for work-related musculoskeletal disorders in the neck among microsurgeons. Surgeons who use loupes and headlamps were found to spend extensive time periods working in non-neutral head–neck postures. These postures, and the use of loupes and headlamps, were found to be associated with an increased loading of the cervical spine, which might cumulatively contribute to occupational neck musculoskeletal disorders. To develop effective control strategies, future studies should focus on the impact of design features of loupes (e.g., mount angles, weight, and shape) on head–neck postures during surgical tasks. TECHNICAL ABSTRACT Background: Work-related musculoskeletal disorders in the neck are common among microsurgeons who operate with loupes and headlamps. Published surveys indicate that microsurgeons across many subspecialties believe that loupes contribute to neck musculoskeletal disorders. However, objective data on head–neck posture and cervical loading during surgical tasks performed using loupes and headlamps are currently lacking. Purpose: This study will assess exposures to physical risk factors for neck musculoskeletal disorders during surgical tasks performed using loupes and headlamp. Methods: A field study was performed in operating rooms to measure the head–neck postures commonly used by three ophthalmic plastic surgeons; a subset of microsurgeons. Posture data were used as input to a biomechanical model to estimate cervical spine loading. Results: During nearly 85% of the time spent operating, surgeons adopted asymmetrical head–neck postures characterized by either bending or rotation of >15°, coupled with flexion of >15°. Postures consisting of flexion ≥45°, 15°–30° bending, and 15°–45° rotation produced significantly higher biomechanical loading of the cervical spine compared to near-neutral postures (i.e., flexion, bending and rotation between 0° and 15°). This loading was further exaggerated by the weight of loupes and headlamp. Conclusions: Non-neutral head–neck postures demanded by the dexterous operating tasks performed using loupes and headlamps could be important biomechanical risk factors for cervical musculoskeletal disorders among microsurgeons.