(I-732) The Surgeon Ergonomic Impact of a Tubular-based Digital Camera to Perform a Sitting Posterior Cervical Foraminotomy: Case Report and Surgical Technique Description with Ergonomic Assessment

Introduction: A posterior cervical decompression can be performed with the patient in a prone or sitting position. The sitting position provides the potential benefit of more facile retraction of surrounding soft tissues, increased operative field and fluoroscopic visualization, as well as decreased epidural bleeding. Unfortunately, the surgeon's ergonomics can be challenging when using the standard operative microscope and may exacerbate musculoskeletal discomfort or injury to the surgeon. We describe a surgical techniques and case report of the use of a small, tubular-based digital camera system to address the ergonomics and safety of this procedure.

Methods: A sterile digital camera was brought into the field to perform a sitting foraminotomy were completed through the tube retractor at both C6-7 and C7-T1 levels. For one half of the procedure, a typical neurosurgical operative microscope was brought into the field to evaluate surgeon ergonomics utilizing the baseline Rapid Entire Body Assessment (REBA) scores for two surgeons of differing stature. The digital camera was inserted onto the tubular retractor and REBA scores were calculated.

Results: The procedure was completed in 53 minutes without any intraoperative complications and the surgeons subjectively reported less muscle strain and fatigue during use of the tubular-based camera system. With a microscope, the taller-statured surgeon scored a 5 on the initial REBA scale and the shorter-stature surgeon scored a 6, placing both in the medium risk category. Once the tubular-based camera was placed, both surgeon's repeated REBA scores were a 3, placing them in the low-risk category.

Conclusion : Utilizing a tubular-based digital camera system, the ergonomics of the surgery are substantially improved. The surgeon can stand closer to the operative field and look directly at a front-facing screen, allowing increased relaxation of the upper extremity and cervical musculature; improving overall ergonomic function.

How to Improve Patient Care: By replacing the bulky microscope with a small, tubular-based digital camera system in a posterior cervical foraminotomy in a sitting position, the ergonomics of the surgery are substantially improved.