The effects of physical workload on cervical sagittal balance in surgeons

Abstract

Aim: Surgeons are exposed to a variety of occupational risks, including work-related musculoskeletal disorders. Occupational necessities such as repetitive movements and long-term inappropriate posture in surgeons may be the cause of neck pain. This study evaluated the cervical sagittal balance parameters of the surgeons. Material and Methods: This cross-sectional study included 57 patients with work-related neck pain between 2016 and 2019.T1S and Cobb angle were measured using magnetic resonance imaging. Personal characteristics of the participants, such as age, body mass index, height, and weight were obtained by a questionnaire filled in at the time of application. Results: Fifty-seven participants were included in the study. Of these, 13 were neurosurgeons, 13 were otolaryngology surgeons, 12 were general surgeons, 11 were plastic surgeons, and 8 were cardiovascular surgeons.The mean age of the surgeons were 38.7 ± 6.44 yearsand the mean VAS of the surgeons were 5.12± 0.73. The mean T1S was 23.2 ° ± 7.95 ° and the mean Cobb angle was 12.3° ± 7.99° In the neurosurgeons, the mean T1S was 22.2 ° ± 11.18 ° and the mean Cobb angle was 8.4 ° ± 5.91 °. Among all surgical branches, neurosurgeons had the lowest mean values in both T1s and cobb angle measurements. Coclusion: The physical workload of surgeons in their daily routines causes the cervical sagittal balance to deteriorate, suggesting that surgeons are in the high-risk group for occupational musculoskeletal diseases.

Keywords

• Neck pain
• Cervical spine
• T1 slope
• cervical lordosis
• surgeon

Cerrahlarda fiziksel iş yükünün servikal sagittal dengeye etkisi

Abstract

Amaç: Cerrahlar, işle ilgili kas-iskelet sistemi bozuklukları da dahil olmak üzere çeşitli mesleki risklere maruz kalmaktadır. Cerrahlarda tekrarlayan hareketler ve uzun süreli uygunsuz duruş gibi mesleki gereklilikler sonucu boyun ağrıları görülebilmektedir. Boyun ağrıları nedenleri arasında servikal sagittal denge parametrelerinin önemli bir yeri vardır. Bu çalışmada cerrahların servikal sagittal denge parametrelerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Bu kesitsel çalışmaya 2016-2019 yılları arasında işle ilgili boyun ağrısı olan 57 hasta dahil edildi. Manyetik rezonans görüntüleme kullanılarak T1S ve Cobb açısı ölçüldü. Katılımcıların yaş, vücut kitle indeksi, boy, kilo gibi kişisel özellikleri başvuru sırasında doldurulan anket ile elde edildi. Bulgular: Çalışmaya elli yedi katılımcı dahil edildi. Bunların 13'ü beyin cerrahı, 13'ü kulak burun boğaz cerrahı, 12'si genel cerrah, 11'i plastik cerrah ve 8'i kalp ve damar cerrahıydı. Cerrahların ortalama yaşı 38,7 ± 6,44 yıl ve ortalama VAS'ı 5,12± 0,73 idi. Ortalama T1S 23,2° ± 7,95° ve ortalama Cobb açısı 12,3° ± 7,99° idi. Beyin cerrahlarında ortalama T1S 22,2° ± 11,18° ve ortalama Cobb açısı 8,4° ± 5,91° idi. Tüm cerrahi branşlar içinde hem T1 hem de cobb açısı ölçümlerinde beyin ve sinir cerrahları en düşük ortalamaya sahipti. Sonuç: Cerrahların günlük rutin iş yükü, servikal sagittal dengenin bozulmasına neden olmakta, bu da cerrahların mesleki kas-iskelet sistemi hastalıkları açısından yüksek risk grubunda olduğunu düşündürmektedir.

Keywords

• Boyun ağrısı
• Servikal omurga
• T1 eğimi
• servikal lordoz
• Cerrah

References

1. Bernard BP, Putz-Anderson V. Musculoskeletal disorders and workplace factors; a critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and low back. 1997.
2. Kraatz S, Lang J, Kraus T, Münster E, Ochsmann E. The incremental effect of psychosocial workplace factors on the development of neck and shoulder disorders: a systematic review of longitudinal studies. International archives of occupational and environmental health. 2013;86:375-95.
3. Bongers PM, Ijmker S, van den Heuvel S, Blatter BM. Epidemiology of work related neck and upper limb problems: psychosocial and personal risk factors (part I) and effective interventions from a bio behavioural perspective (part II). J Occup Rehabil. 2006;16:272-95.
4. Karpansalo M, Manninen P, Lakka TA, Kauhanen J, Rauramaa R, Salonen JT. Physical workload and risk of early retirement: prospective population-based study among middle-aged men. Journal of occupational and environmental medicine. 2002:930-9.
5. Schneider SP. Musculoskeletal injuries in construction: a review of the literature. Appl Occup Environ Hyg. 2001;16(11):1056-64.
6. Soueid A, Oudit D, Thiagarajah S, Laitung G. The pain of surgery: pain experienced by surgeons while operating. International Journal of Surgery. 2010;8(2):118-20.
7. Dorion D, Darveau S. Do micropauses prevent surgeon's fatigue and loss of accuracy associated with prolonged surgery? An experimental prospective study. J Vasc Surg. 2013;57(4):1173.
8. Hardacker JW, Shuford RF, Capicotto PN, Pryor PW. Radiographic standing cervical segmental alignment in adult volunteers without neck symptoms. Spine. 1997;22(13):1472-9.

9. Viikari-Juntura E, Martikainen R, Luukkonen R, Mutanen P, Takala E, Riihimäki H. Longitudinal study on work related and individual risk factors affecting radiating neck pain. Occupational and environmental medicine. 2001;58(5):345-52.
10. Nordander C, Ohlsson K, Åkesson I, Arvidsson I, Balogh I, Hansson G-Å, et al. Risk of musculoskeletal disorders among females and males in repetitive/constrained work. Ergonomics. 2009;52(10):1226-39. 11. Li J, Qin S, Li Y, Shen Y. Modic changes of the cervical spine: T1 slope and its impact on axial neck pain. J Pain Res. 2017:2041-5.
11. Grob D, Frauenfelder H, Mannion A. The association between cervical spine curvature and neck pain. Eur Spine J. 2007;16:669-78.
12. Silverstein BA, Viikari-Juntura E, Fan ZJ, Bonauto DK, Bao S, Smith C. Natural course of nontraumatic rotator cuff tendinitis and shoulder symptoms in a working population. Scand J Work Environ Health. 2006:99-108.
13. Arvidsson I, Hansson G-Å, Mathiassen SE, Skerfving S. Neck postures in air traffic controllers with and without neck/shoulder disorders. Applied ergonomics. 2008;39(2):255-60.
14. McAviney J, Schulz D, Bock R, Harrison DE, Holland B. Determining the relationship between cervical lordosis and neck complaints. J Manipulative Physiol Ther. 2005;28(3):187-93.
15. Yip CHT, Chiu TTW, Poon ATK. The relationship between head posture and severity and disability of patients with neck pain. Man Ther. 2008;13(2):148-54.
16. Lau KT, Cheung KY, Chan MH, Lo KY, Chiu TTW. Relationships between sagittal postures of thoracic and cervical spine, presence of neck pain, neck pain severity and disability. Man Ther. 2010;15(5):457-62.
17. Iyer S, Nemani VM, Nguyen J, Elysee J, Burapachaisri A, Ames CP, et al. Impact of cervical sagittal alignment parameters on neck disability. Spine. 2016;41(5):371-7.
18. Miyazaki M, Hymanson HJ, Morishita Y, He W, Zhang H, Wu G, et al. Kinematic analysis of the relationship between sagittal alignment and disc degeneration in the cervical spine. Spine. 2008;33(23):E870-E6.
19. Jun HS, Kim JH, Ahn JH, Chang IB, Song JH, Kim TH, et al. T1 slope and degenerative cervical spondylolisthesis. Spine. 2015;40(4):E220-E6.
20. Scheer JK, Tang JA, Smith JS, Acosta FL, Protopsaltis TS, Blondel B, et al. Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine. 2013;19(2):141-59.
21. Yang B-S, Lee S-K, Song K-S, Yoon S-P, Jang G, Lee C-C, et al. The use of T1 sagittal angle in predicting cervical disc degeneration. Asian Spine J. 2015;9(5):757.
22. Khayatzadeh S, Kalmanson OA, Schuit D, Havey RM, Voronov LI, Ghanayem AJ, et al. Cervical spine muscle-tendon unit length differences between neutral and forward head postures: biomechanical study using human cadaveric specimens. Phys Ther. 2017;97(7):756-66.
23. Alix ME, Bates DK. A proposed etiology of cervicogenic headache: the neurophysiologic basis and anatomic relationship between the dura mater and the rectus posterior capitis minor muscle. J Manipulative Physiol Ther. 1999;22(8):534-9.
24. Vijendren A, Yung M, Sanchez J, Duffield K. Occupational musculoskeletal pain amongst ENT surgeons–are we looking at the tip of an iceberg? The Journal of Laryngology & Otology. 2016;130(5):490-6.
25. Nimbarte AD, Sivak-Callcott JA, Zreiqat M, Chapman M. Neck postures and cervical spine loading among microsurgeons operating with loupes and headlamp. IIE Transactions on Occupational Ergonomics and Human Factors. 2013;1(4):215-23.
26. Andersen JH, Haahr JP, Frost P. Risk factors for more severe regional musculoskeletal symptoms: A two‐year prospective study of a general working population. Arthritis Rheum. 2007;56(4):1355-64.
27. Miranda H, Punnett L, Viikari-Juntura E, Heliövaara M, Knekt P. Physical work and chronic shoulder disorder. Results of a prospective population-based study. Ann Rheum Dis. 2008;67(2):218-23.
28. Ariens GA, Van Mechelen W, Bongers PM, Bouter LM, Van Der Wal G. Physical risk factors for neck pain. Scand J Work Environ Health. 2000:7-19.
29. Ariëns G, Bongers P, Douwes M, Miedema M, Hoogendoorn W, van der Wal G, et al. Are neck flexion, neck rotation, and sitting at work risk factors for neck pain? Results of a prospective cohort study. Occupational and environmental medicine. 2001;58(3):200-7.