Medical Student Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Cleveland, Ohio, United States
Introduction: Surgeons are reported to have a higher prevalence of work-related musculoskeletal disorders (MSDs) than the general population. There is a need for greater understanding of the burden of MSDs in spine surgeons, their impact on practice, and risk factors contributing to MSDs, including surgical instrument design and surgical ergonomics.
Methods: An anonymous REDCap survey was distributed via email to the departments of several academic and private centers across the United States, as well as to the AANS/CNS Women in Neurosurgery Section email list. T-tests and Chi-square tests were used to compare responses by gender. Multiple linear regression analysis was performed to identify predictors of discomfort in instrument utilization.
Results: 60 responses (14.5% response rate) were complete and included in the analysis. 43 respondents (72%) had experienced an MSD. Neck MSDs were most common, occurring in 36 (60%) respondents. Aside from a greater rate of treatment for trigger finger in women (12.5% vs. 0, p = 0.03), there were no significant gender-based differences in MSD rates, rates of treatment for MSDs, or lost time at work related to MSDs. Women (40%) were more likely than men to report difficulty in instrument grip, comfort, and use on a 20-point Likert scale (mean 10.7 vs. 15.4, p < 0.0001). This effect persisted when adjusting for glove size and days per week spent operating (p = 0.002). Specifically, women were less likely to agree that the handles of surgical instruments were an appropriate grip (p < 0.0001), that they rarely experienced difficulty when using them (p < 0.0001), and that they rarely needed to use two hands with instruments meant to be used with one hand (p < 0.0001).
Conclusion : MSD burden in spine surgeons is substantial, with 72% of respondents in this survey experiencing at least one MSD. While there was no evidence of gender differences in MSD rates and severity, female surgeons report significantly more discomfort with the use of surgical instruments.
How to Improve Patient Care: Although survey responses did not indicate gender differences in MSD rates, female spine surgeons face unique ergonomic challenges in instrument use, which should be taken into account by trainees, surgeons, and medical device companies.
