A RELEVANT SOLUTION TO SURGICAL ERGONOMIC DISTRESS

A RELEVANT SOLUTION TO SURGICAL ERGONOMIC DISTRESS
NekSpineTM

Introducing a spinal support exoskeleton designed to reduce the stress on the
cervical, thoracic, and lumbar spine regions experienced during surgical and
dental procedures.

Written by Alvin C. Mayshack, MSME
Director of Marketing, Composite Manufacturing Incorporated

Introduction

The physicality required to perform surgery
necessitates awareness of the stress and strain placed
on the body and requires action from the clinician
to protect themselves. At risk is the short term and
future quality of life and potentially, longevity of
their careers. Effort has gone forth in industry to
develop mitigations. Proper positioning of monitors,
ergonomic focused instrumentation, awareness
training on forward head positions, improper shoulder
elevation, postural reset and motion strategies are all
mitigations that have been introduced in the past
to attempt to help the surgeon counterbalance the
prolonged and awkward positions that can lead to
pain, fatigue and degenerative changes.1

The OR is a stressful environment which can be
further magnified by the physical requirements of
attaining surgical access and visibility for long periods
of time. Pain impacts work in many ways beginning
with the physical challenges but it also can affect
communication and collaboration especially in a
dynamic surgical environment. Negative emotions
are contagious especially when they emanate from
leadership in the room. Ultimately, in the OR and in
the dental operatory the patient comes first. Clinicians
commonly accept the fact that pain and discomfort is
part of the job. It is almost a badge of honor to be
able to push through and sacrifice for the patient.

The white paper authored by Heather Kookier 2022
titled, “Do No Let Poor Ergonomics Cut your Career
Short: Heavy is the Head”2, tackles the awareness of
the growing trend of Musculoskeletal disorders in the
surgical and dental community. Kookier sites one of the more popular mitigations that is growing in practice is
Targeted Stretching Micro Breaks (TSMBS) which has proven to provide some level of relief and aid in mental focus
but does come with the tradeoff of increased time to the procedure.3 Other solutions such as haptic feedback
remind the user of their position and depend on the user to act which may or may not be possible based on the
situation and requirements for surgical access.

A solution that lends itself more appropriately to the
environment is one that is more passive in nature and
would not require a response and action from the
user. That solution would allow the user unrestricted
movement, create postural awareness, and still
accomplish its purpose of reducing the wear and tear
that occurs over time due to repetitive stress. That
solution is the NekSpine Exoskeleton.

NekSpineTM by CMI (Composite

Manufacturing Inc.)

NekSpineTM is a biomedically engineered spinal support
system designed to reduce the stress on the cervical,
thoracic and lumbar spine regions experienced during
routine repetitive and awkward positions necessary
for access during surgical and dental procedures. The
product allows free range of motion while providing
prophylactic care for the user. The user invests a small
amount of time up front in determining their comfort
settings and becoming familiar with the feel of the
device. From there, the product can be used daily as
a normal part of the PPE or on a case-by-case basis as
determined by the length and expected stress during
cases.

NeKSpine utilizes a lightweight vest with an integrated
carbon fiber spine member used in conjunction with
a lightweight carbon fiber head frame to provide
support specifically targeted at the cervical region but
also along the entire spine.

THE BODY VEST

Manufactured from a lightweight, strong material
commonly used in military applications where weight,
breathability and durability are key performance
characteristics. Laser cut and optimized for weight,
support, padding and fit, the vest comes in multiple
sizes designed to cover the population of body sizes
and shapes.

The posture supporting/correcting lumbar support
system of the vest provides trunk compression and
stability and is ideal for active positions required by
surgical and dental procedures.

Cinching the shoulder straps and chest strap helps
to maintain good shoulder posture. The padded
shoulders and waist allow the vest to do its job of
facilitating the transfer of load from the cervical spine
with comfort.

THE SUPPORT BEAM

The support beam is a carbon fiber I-beam structure
tuned to provide the proportional counterbalance
to offset the load of the head. The support beam is
integrated into the vest and provides structure along

the cervical, thoracic and lumber regions along the
entire spine. The tie-in of the beam to the vest and the
head frame facilitates the load transfer of the head
to the hips. The I-beam composite structure provides
a critical performance characteristic of having high
stiffness to weight ratio. 20% of the weight of steel
but with a 3X strength factor, the combination of the
beam and ergonomic vest design provides the user
with a comfortable but highly effective biologically
engineered device.

HEAD FRAME

The head frame provides the means to connect the
user’s head to the spine beam via a titanium Teflon
coated wire. It is termed a frame verses a head
band because its function is different than that of a
surgical headlight band. The NekSpine Head Frame
is fabricated from lightweight and extremely strong
carbon fiber. Rigidity is a key component to facilitating
the load transfer while ergonomically interfacing with
the bony structures of the user’s head.

The head frame can be adjusted to fit the user’s head
structure in the same manner as a traditional head
light band. The top knob adjusts the cap depth and the
rear knob is used to adapt to the head circumference.
The critical function of the head frame is facilitated by
the connection of the slider block to the carbon spine
via a rolling titanium wire. The wire moves smoothly
through the slider block allowing for unrestricted
head turn motion.

The color-coded tension adjustment knobs on each
side of the frame allow the user to counterbalance
the head forward load to the desired level. That level
can be light or heavy based on the application. A
heavier application of tension may be desired for
those cases longer in duration that require extensive
head forward positioning.

For those surgeons that utilize headlamps for
additional illumination, NekSpine offers the Quasar
Premium Headlight System which is integrated directly
into the head frame. For surgeons or dentists with
other headlamp preferences, CMI can mount your
brand directly to the NekSpine.

Conclusion

NekSpine is the first and only true solution to
address the issue of cervical stress experienced
during procedures. This wearable system integrates
seamlessly into the surgeon or dentist workflow to
provide prophylactic care of the entire spine. The
integration of this solution into the surgeon or
dentist’s daily routine can improve the quality of life
today and potentially extend the viability of your
career for tomorrow.

References

Andrew T. Schlussel, Justin A. Maykel, “Ergonomics and
Musculoskeletal Health of the Surgeon”, Clinics in Colon
and Rectal Surgery, 2019: 32(06): 424 – 434
Heather Kookier, MSN, RN, CML, CNOR, DRNFA; “Do Not
Let Poor Ergonomics End Your Caregiving Career: Heavy is
the Head”, 2022.
Adrian E Park, “Intraoperative “Micro Breaks” With
Targeted Stretching Enhance Surgeon Physical Function
and Mental Focus: A Multicenter Cohort Study”, Annals of
Surgery, 2017 Feb; 265(2): 340- 346