Sharing Experiences, Lessons Learned from My Own Medical Leave

I’ve heard that surgeons are at risk for cervical spine issues, but had never known any otolaryngology colleague who had experienced them. As I read online all about the symptoms and treatment options for cervical radiculopathy, I found several studies that had been published in the past two years on the topic of work-related musculoskeletal disorders (WMSD) and ergonomics in various surgical subspecialties— especially vascular surgery, robotics, neurosurgery, and laparoscopic or endoscopic surgeries.

On a recent trip to Houston, I shared with a small group of colleagues what I was going through. One showed me his scar from an anterior cervical discectomy and fusion 10 years ago; another shared that he had experienced radiculopathy four years ago. A third colleague said that her spouse, a vacular surgeon, had had to give up his surgical career 8 years ago due to radiculopathy.

I learned that I was not alone. Surgeons struggle privately in silence, likely trying to avoid stigma and not wanting to create concerns in patients and colleagues. The literature bears this out:

• • • A survey study of 685 orthopedic surgeons from 27 states found that 59.3% reported neck pain and 22.8% reported cervical radiculopathy. Adjusting for age and sex, surgeons who performed arthroscopy had an odds ratio of 3.3 for neck pain. Older age and higher stress levels were associated factors. Only five surgeons with neck pain and one with cervical radiculopathy ever had an ergonomic evaluation (J Am Acad Orthop Surg. 2020;28:730-736).
    • A literature review on the topic of ergonomics in surgery found WMSDs reported at 66% to 95% for open surgery, 73% to 100% for conventional laparoscopy, 54% to 87% for vaginal surgery, and 23% to 80% for robotic-assisted surgery. Risk factors for injury in open surgery include loupes, headlamps, and microscopes. Unique risks in laparoscopic surgery included table and monitor position, long-shafted instruments, and poor instrument handle design. Robotic surgery was associated with trunk, wrist, and finger strain. Surgeon WMSDs often resulted in disability but were under-reported to institutions (Female Pelvic Med Reconstr Surg. 2018;24:1-12).
    • A survey study from the European Association of Endoscopic Surgery on musculoskeletal (MSK) pain and burnout in 569 surgeons reported pain levels of 3 or higher (on a scale of one to 10) in the prior week in 62% of endoscopists, as well as in 71% of open surgeries, 72% of laparoscopic surgeries, 48% of robot-assisted cases, and 52% of endoscopies. Only 120 of 569 surgeons ever sought medical help for pain or discomfort, 38% were currently in pain, 16% had considered leaving surgery, 26% had been on short-term disability during their career, and 4% were on long-term disability. Surgeons who felt physical discomfort that influenced their ability to perform procedures reported lower satisfaction from work, higher burnout, and higher callousness toward people than those not fearing the loss of their career longevity (Surg Endosc. 2019;33:933-940).
    • An intraoperative observation and survey study was done using the Rapid Entire Body Assessment score system. Researchers evaluated the presence of postural-related strain and musculoskeletal discomfort, along with the level of ergonomic training and the availability of ergonomic equipment amongst otolaryngology surgeons. Of 70 surgeons, 72% reported some level of back pain, with cervical spine pain being the most common; 43.8% of surgeons reported the highest level of pain when standing, 12.5% experienced pain when sitting, 10% stated that pain impacted their work, and only 24% reported any prior ergonomic training. Residents were equally affected when compared to senior surgeons in observational risk analysis and subjective survey reports (Laryngoscope. 2019;129:370-376).
    • Most otolaryngologists experience occupational physical discomfort— rhinologists in particular. Only one study utilized surface electromyography to document physical findings directly associated with endoscopic sinus surgery. Surgeon fatigue and bodily injury were surprisingly frequent in occurrence and were more likely to occur during procedures that are mentally challenging, prolonged, and that require surgeons to operate in fixed position (Curr Opin Otolaryngol Head Neck Surg. 2019;27:25-28).
    • For all otologists and neurotologists, Dr. Lustig and co-authors extrapolated from other surgical professions that cervical and lumbar pain related to prolonged static sitting and neck flexion when working with a microscope are occupational hazards for MSK disorders. Recommendations to incorporate healthy ergonomics into surgical training, as well as adopting correct posture and use of ergonomically designed equipment, may mitigate long-term risks (Otol Neurotol. 2020;4:1182-1189).

Lessons Learned

While on medical leave, I’ve been able to replace 10 to 11 hours of caring for others with three hours of daily physical therapy for my neck and shoulder, chiropractor adjustments,decompression machines for my cervical spine, and twice weekly massage therapy to work on the muscular rigidity of my neck and shoulder. In addition, I’ve had weekly counseling to process all my emotions as I face uncertainty while acknowledging years of “self-abandonment.”