• Dorian M Kusyk, Seung Jeong, Ethan Fitzgerald, Brandon Kaye, Jenna Li, Richard Williamson, and Alexander K Yu.
• Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
• World Neurosurg. 2024 Jan 1; 181: e562e566e562-e566.

BackgroundSurgeons sustain deviated postures during procedures even with the use of loupes or an operative microscope. The surgical exoscope is a new intraoperative visualization technology designed to improve surgical ergonomics; however, no objective data exist to say that surgeon posture is significantly improved. This study aimed to quantify the difference in posture during standard anterior cervical spine procedures performed with the aid of an operative microscope versus an exoscope.MethodsThis was a prospective cohort study utilizing a posture-sensing device at the surgeon's cervicothoracic junction. The primary outcome was the proportion of time under scope spent in a deviated posture, defined as greater than 10 degrees of deviation from neutral in the x- and y-axes (flexion/extension and lateral bending) of the surgeon's upper torso. Average deviation from baseline for the x-, y-, and z-axes (flexion/extension, lateral bending, and axial rotation, respectively), as well as the percentage of operative time spent with the visualization aid was also analyzed.ResultsOverall, 37 anterior cervical procedures were recorded: 18 were performed with an exoscope and 19 with a microscope. Surgeons spent significantly more time in the deviated posture with the operative microscope than with the exoscope (32% vs. 8% with x-axis >10 deg, P <0.005; 20% vs. 6% with y-axis >10 deg, P <0.05). This is also reflected by the significant differences in the average deviation in the x- and y-axes, while under scope.ConclusionsUtilizing the exoscope for anterior cervical spine procedures allows surgeons to spend less time in a deviated posture.Copyright © 2023 Elsevier Inc. All rights reserved.

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