Surgeon Ergonomics of Lateral Lumbar Interbody Fusion Across Four Patient Positions: A Proof-of-Concept Simulation Study Using Motion Capture and Electromyography.
10 affiliations
- 1Virginia Mason Medical Center, Center for Neurosciences and Spine, Seattle, WA, USA.
- 2Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, WA, USA.
- 3University of Vermont Larner, College of Medicine, Burlington, VT, USA.
- 4Virginia Tech Carilion School of Medicine, Virginia Polytechnic Institute and State University, Roanoke, VA, USA.
- 5Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, VA, USA.
- 6Department of Neurosurgery, Kaiser Permanente Orange County - Irvine Medical Center, Irvine, CA, USA.
- 7Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, CA, USA.
- 8Department of Orthopaedic Surgery, Keio University School of Medicine Graduate School of Medicine, Yokohama, Kanagawa, Japan.
- 9Tulane University, School of Medicine, New Orleans, LA, USA.
- 10Department of Orthopedic Surgery, Mayo Clinic Minnesota, Rochester, MN, USA.
Abstract
Study DesignProof-of-concept simulation-based biomechanical pilot study.ObjectivesTo compare surgeon posture and muscle activity across four lateral lumbar interbody fusion (LLIF) positions and rank them by overall ergonomic burden.MethodsFive right-handed spine surgeons (case volumes 15 to 500 or more) each simulated a single-level LLIF on a synthetic model in four positions, three using direct vision (lateral decubitus, prone seated, prone lateral) and one using a camera and monitor (prone camera). Whole-body motion capture and surface EMG were recorded simultaneously, analyzed by surgical phase, and summarized per surgeon.ResultsNeck-flexion intensity was greatest in lateral decubitus and lower in every prone position, with the same ranking in all five surgeons (exact Friedman p=3.0e-06, Kendall W=1.00). Arm elevation was highest in prone seated. Across four summaries of posture and muscle activity, prone camera was the most favorable position in every surgeon, while the others reordered by measure. All positions scored medium-to-high risk. No two-position comparison reached adjusted significance, as expected at this sample size.ConclusionsPatient position in LLIF does not appear to change patient outcome, but it changes what the operation costs the surgeon. Lateral decubitus loaded the neck in every surgeon regardless of case volume or preference, prone seated loaded the shoulder, and prone camera was most favorable overall. Surgeons can reduce their exposure through position and setup, and ergonomics offers an objective way to compare setups when patient outcomes cannot separate them. These are proof-of-concept findings in five surgeons and require confirmation in a larger sample.
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BibTeX
@article{louie2026surgeon,
title = {{Surgeon Ergonomics of Lateral Lumbar Interbody Fusion Across Four Patient Positions: A Proof-of-Concept Simulation Study Using Motion Capture and Electromyography.}},
author = {Philip K Louie and Anthony Y Jeong and Renzo A Laynes and Mir Amaan Ali and Kento Yamanouchi and Kenneth T Nguyen and Jean-Christophe Leveque and Venu M Nemani and Aiyush Bansal},
journal = {Global spine journal},
year = {2026},
month = oct,
doi = {10.1177/21925682261501085},
url = {https://europepmc.org/article/MED/42948921},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Surgeon Ergonomics of Lateral Lumbar Interbody Fusion Across Four Patient Positions: A Proof-of-Concept Simulation Study Using Motion Capture and Electromyography.
AU - Philip K Louie
AU - Anthony Y Jeong
AU - Renzo A Laynes
AU - Mir Amaan Ali
AU - Kento Yamanouchi
AU - Kenneth T Nguyen
AU - Jean-Christophe Leveque
AU - Venu M Nemani
AU - Aiyush Bansal
PY - 2026
DA - 2026/10/28
JO - Global spine journal
DO - 10.1177/21925682261501085
UR - https://europepmc.org/article/MED/42948921
AB - Study DesignProof-of-concept simulation-based biomechanical pilot study.ObjectivesTo compare surgeon posture and muscle activity across four lateral lumbar interbody fusion (LLIF) positions and rank them by overall ergonomic burden.MethodsFive right-handed spine surgeons (case volumes 15 to 500 or more) each simulated a single-level LLIF on a synthetic model in four positions, three using direct vision (lateral decubitus, prone seated, prone lateral) and one using a camera and monitor (prone camera). Whole-body motion capture and surface EMG were recorded simultaneously, analyzed by surgical phase, and summarized per surgeon.ResultsNeck-flexion intensity was greatest in lateral decubitus and lower in every prone position, with the same ranking in all five surgeons (exact Friedman p=3.0e-06, Kendall W=1.00). Arm elevation was highest in prone seated. Across four summaries of posture and muscle activity, prone camera was the most favorable position in every surgeon, while the others reordered by measure. All positions scored medium-to-high risk. No two-position comparison reached adjusted significance, as expected at this sample size.ConclusionsPatient position in LLIF does not appear to change patient outcome, but it changes what the operation costs the surgeon. Lateral decubitus loaded the neck in every surgeon regardless of case volume or preference, prone seated loaded the shoulder, and prone camera was most favorable overall. Surgeons can reduce their exposure through position and setup, and ergonomics offers an objective way to compare setups when patient outcomes cannot separate them. These are proof-of-concept findings in five surgeons and require confirmation in a larger sample.
SN - 2192-5682
SN - 2192-5690
ER -