A nationwide perspective on ergonomic gaps in spine surgery: modifiable risk factors and gender-based findings

Study Design: Cross-sectional questionnaire-based study. Purpose: To determine the prevalence, anatomical distribution, and modifiable ergonomic risk factors for work-related musculoskeletal disorders (MSDs) among early-career spine surgeons in India, with an emphasis on gender-based differences. Overview of Literature: Although MSDs are a well-recognized occupational hazard for surgeons, a large portion of existing spine surgery literature originates from high-income countries, focuses on low back pain, and lacks targeted evaluation of early-career surgeons in low- and middle-income countries. Consequently, gender-specific ergonomic challenges remain underexplored. Methods: A nationwide, cross-sectional online survey was conducted (January-June 2025) among spine surgeons with <10 years of independent practice experience. The questionnaire assessed the demographics, operative workload, ergonomic practices, equipment use, and MSD symptoms over the past 12 months. Associations were evaluated using χ2 or Fisher's exact tests, as appropriate, and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) derived from multivariable exact logistic regression. Results: A total of 764 surgeons (mean age, 35.4±4.5 years; 19.6% women) participated. MSD prevalence was 83.9%, with 96.1% of symptomatic surgeons reporting neck discomfort. All women reported MSD, whereas only 80.0% of men did so (p<0.001). Microscope use was significantly associated with neck discomfort (aOR, 1.65; 95% CI, 1.14-2.39; p=0.009), whereas loupe use was not. Consistent table height adjustment was associated with markedly decreased MSD prevalence (72.8% vs. approximately 100%; aOR, 0.21; 95% CI, 0.05-0.88; p=0.03). Only 6.7% of the respondents reported preoperative ergonomic planning, despite frequent assistant-surgeon height mismatch (63.8%). Conclusions: This nationwide survey of young spine surgeons in India revealed an unprecedented neck-dominant MSD pattern, universal MSD prevalence among female surgeons, and a strong protective effect of consistent table height adjustment. These findings underscore the urgent need for targeted ergonomic training, visualization tool optimization, and integration of ergonomic planning into surgical workflows.