Prevalence of work-related musculoskeletal pain among neurosurgeons and trainees in the Philippines

Prevalence of work-related musculoskeletal pain among neurosurgeons and trainees in the Philippines | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of work-related musculoskeletal pain among neurosurgeons and trainees in the Philippines Sean Kendrich Cua, Juan Silvestre Pascual, Mary Angeline Luz Hernandez, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6966022/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Jan, 2026 Read the published version in Neurosurgical Review → Version 1 posted 13 You are reading this latest preprint version Abstract Background Work-related musculoskeletal pain has become a growing concern in the practice of neurosurgery. Methods A cross-sectional online survey study was conducted among neurosurgery consultants and residents in the Philippines. The survey was adapted from previously published literature on work-related musculoskeletal pain in surgical specialties, and consisted of questions for demographic data, case load, operating room ergonomics, and the Borg pain scale for five index neurosurgical operations: supratentorial craniotomy (SC), infratentorial craniotomy (IC), transsphenoidal surgery (TS), ventriculoperitoneal shunt (VPS) insertion, and spine surgery (SS). Results A total of 100 respondents (56 consultants and 44 residents) were obtained, with a response rate of 46% (100/217). The mean pain scores were greater in residents than consultants across all anatomic regions and index operations. For consultants, the greatest prevalence of pain was found at the neck (SC 76.8%, IC 89.3%, TS 69.6%, VPS 33.9%, and SS 71.4%). For residents, it was at the lower back (SC 84.1%, IC 86.4%, TS 75.0%, VPS 47.7%, and SS 79.5%). The most common intraoperative response was to stretch or change the height of the neurosurgical field or microscope angulation, while the most common behavioral response was increased irritability and decreased patience. Discussion Consultants, who are older and have more medical and musculoskeletal comorbidities, but have more experience in the practice of neurosurgery and more time devoted to exercise, had lower pain scores than residents. Future studies can be geared towards instituting ergonomic training and educational programs for consultant and resident health. Musculoskeletal pain neurosurgery ergonomics Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Among health care workers, procedural medical specialists are more commonly at risk for developing musculoskeletal pain due to the nature of their work [ 1 ]. These injuries are classified as “work-related musculoskeletal disorders,” which have gained an increased level of interest over the past few years due to their impact on both surgeons and patient care [ 2 – 4 ]. Neurosurgeons, in particular, are prone to develop acute or chronic injuries given the physical strain and long hours of their procedures [ 2 – 4 ]. Gadjradj et al. reported that 73.6% of all neurosurgeons experience work-related musculoskeletal concerns, particularly in three procedures: lumbar discectomy, ventriculoperitoneal shunt (VPS) insertion, and endoscopic third ventriculostomy. These were identified to cause neck, shoulder, and back complaints primarily [ 4 ]. Most neurosurgeons also perform craniotomies and other spine surgeries, which have been reported to cause pain in the same anatomic regions, as well as the elbows and wrists [ 2 – 3 , 5 – 6 ]. Most of the pain was attributed to the repetitive use of bone rongeurs, high speed drills, and VPS passers, as well as the concentrated tension in keeping microsurgical tools steady for the duration of the surgery [ 3 ]. All of these may contribute to an increased risk of repetitive strain injury, carpal tunnel syndrome, and wrist or hand dysfunction [ 3 ]. In addition to the instruments used in neurosurgery, magnification is a mainstay in most cranial and spinal procedures, and may contribute to work-related musculoskeletal pain. It comes in the form of surgical loupes, microscopes, and endoscopes. Although they are beneficial in providing ample visualization of the surgical field, prolonged use has been reported to lead to spinal stiffness, neck strain, and eye strain [ 2 – 3 , 7 ]. The use of lead gowns or aprons in spinal surgery, which may weigh up to 5–8 kg, have also led to increased fatigue and strain on the muscles of the upper and lower back [ 2 – 4 , 8 ]. These disorders may contribute to a decrease in the quality of the neurosurgeon’s performance, decrease in general well-being, and an increase in occupational burnout and mental health issues [ 2 – 4 , 6 – 7 ]. There has also been an increase in absenteeism of doctors, leading to decreased career longevity. Overall, these disorders may also cause a general decrease in the quality of neurosurgical patient care [ 5 , 7 , 9 – 12 ]. Given this, the investigators aimed to determine the work-related musculoskeletal pain and associated problems neurosurgeons (consultants) and neurosurgical trainees (residents) in the Philippines experience. This was done by performing an online survey among the members of the Association of Filipino Neurosurgeons Inc. (AFNI) and Philippine Association of Neurosurgical Residents (PANSR). This information will be beneficial in determining the possible areas of ergonomic improvement for neurosurgeons, as well as offering insights to policies that may be formed to help improve the general well-being of the neurosurgeons in our country. MATERIALS AND METHODS This was a cross-sectional study utilizing an online survey of consultants and residents who are members of AFNI and PANSR, respectively. The survey was developed and adapted to our setting by the study authors. This was based on different validated and published literature as well as a focus group discussion conducted among consultants and residents of different ages and year levels in the authors’ institution [ 2 , 4 , 6 ]. Pilot testing was performed in the same setting to determine content, construct, and face validity of the survey. The survey was revised and streamlined based on comments of participants and observations of the study authors during the pilot testing. The final 64-item survey included questions on the following: demographics, pertinent past medical history, procedures performed and regularly assisted by the surgeon, anatomic distribution of pain (head, eyes, teeth, neck, shoulders, upper back, elbows, wrist/hand, lower back, hips/thighs, knees, and ankles/feet) based on five index operations, and behaviors and responses of the surgeon to address the work-related musculoskeletal pain [ 2 ]. The five index operations were supratentorial craniotomy (SC), infratentorial craniotomy (IC), transsphenoidal surgery (TS), ventriculoperitoneal shunt insertion (VPS), and spine surgery (SS). Pain was measured using the Borg 0–10 scale [ 11 , 13 , 14 ]. A sample of the data collection form can be seen in Appendix 1. The survey was administered in September 2024 using Google Forms (Google LLC, United States) and distributed via Telegram (Telegram FZ LLC, British Virgin Islands), Viber (Rakuten Inc., Israel), and text messaging and electronic mail to the 121 members of AFNI and 96 resident members of PANSR [ 15 ]. The complete list of participants was obtained through the AFNI website and PANSR directory. Neurosurgery training in the Philippines consists of one year of general surgery followed by five years of neurosurgery; we did not include the trainees who were still in general surgery. Reminder messages were sent after the first and third week of initial distribution. Survey responses were anonymized. The authors state that this research was conducted in accordance with the Helsinki Declaration as revised in 2013. Statistical analysis The data gathered was compared between consultants and residents, using pain scores as the main outcome variable. A Shapiro-Wilk test was performed to determine normality of the pain scores. Afterwards, a Mann-Whitney U test was used to compare scores between the two groups. Statistical significance was set at 0.05. The statistical software used was R (R Core Team, Vienna, Austria). RESULTS Demographic, Clinical, and Work-related Data We had a total of 100 respondents (56 consultants and 44 residents), with a response rate of 46% (100/217). Consultants and residents had the following characteristics, respectively: mean ages of 48 (SD = 9.7) and 31.5 years (SD = 3.1), were mostly male (83.9% and 68.2%), mostly right-handed (85.8% and 84.1), and on average had a BMI of 27.7 (SD = 4) and 26.5 (SD = 4.5). Among the consultants, the most common comorbid condition was hypertension (n=23) followed by diabetes mellitus (n=14). The most commonly reported musculoskeletal condition was degenerative lumbar disease (n=10), followed by cervical spondylosis (n=7). Eleven consultants had a history of musculoskeletal injury for which two of them underwent surgery. Majority exercised between 0.5-4 hours a week (55.4%, n = 31). Only 7.2% of consultants (n=4) reported the regular use of analgesics of at least once a month. In general, they had an average tenure of 14.6 years (SD = 9.8) and practiced neurosurgery in both private and public hospitals (60.7%, n = 34). In comparison, majority of the residents did not have a comorbid condition (n=40). The most common musculoskeletal condition reported in this group was gouty arthritis (n=3), and only five reported a history of musculoskeletal injury, none of which required surgery. Most did not exercise at all (43.2%, n = 19) or only exercised 0.5-4 hours a week (40.9%). Residents were also distributed evenly among the first to fifth years of their neurosurgical training and mostly practiced in the public setting (61.4%, n=27). Table 1 shows the summary of the demographic, clinical, and work-related data. Index Operations Tables 2 and 3 summarize the operative data for the five index operations. Consultants more commonly reported being the primary surgeons for their cases (SC 98.2%, IC 96.4%, TS 83.9%, VPS 100%, and SS 91.1%). Residents, on the other hand, more commonly reported being the assists for these cases (SC 52.3%, IC 63.6%, TS 79.5%, VPS 34.1%, and SS 75.0%). In all five index operations, both consultants and residents preferred to stand. Table 1. Demographic, clinical, and work-related data among the respondents Consultants Residents n 56 44 Age (years, Mean + SD) 48.0 + 9.7 31.5 + 3.1 Sex (Male, %) 47 (83.9%) 30 (68.2%) Height (cm, Mean + SD) 168.5 + 8.4 164.9 + 8.7 Weight (kg, Mean + SD) 78.8 + 13.0 72.3 + 14.0 BMI (kg/m 2 , Mean + SD) 27.7 + 4 26.5 + 4.5 Handedness (n, %) Right Left Ambidextrous 48 (85.8%) 4 (7.1%) 4 (7.1%) 37 (84.1%) 6 (13.6%) 1 (2.3%) Comorbid conditions (n, %) Hypertension Diabetes Mellitus Heart disease Others (dyslipidemia, pulmonary disease, endocrine disease, etc.) 23 (41.1%) 14 (25.0%) 4 (7.2%) 6 (10.7%) 3 (6.8%) 1 (2.3%) 0 (0%) 2 (4.5%) Musculoskeletal conditions (n, %) Degenerative lumbar disease Cervical Spondylosis Osteoarthritis Gouty arthritis Others (scoliosis, carpal tunnel syndrome, de Quervain’s tenosynovitis, ligamentous injuries, thoracic spondylitis, etc.) 10 (17.9%) 7 (12.5%) 5 (8.9%) 2 (3.6%) 7 (12.5%) 0 (0%) 1 (2.3%) 0 (0%) 3 (6.8%) 7 (15.9%) History of musculoskeletal injury (n, %) 11 (19.6%) 5 (11.4%) History of surgery for musculoskeletal injury (n, %) 2 (3.6%) 0 (0.0%) Analgesic use (n, %) None As needed Regular 39 (69.6%) 13 (23.2%) 4 (7.2%) 32 (72.7%) 7 (15.9%) 5 (11.4%) Exercise activity (n, %) None 0.5-4 hours a week 4-7 hours a week More than 7 hours a week 10 (17.9%) 31 (55.4%) 12 (21.4%) 3 (5.4%) 19 (43.2%) 18 (40.9%) 5 (11.4%) 2 (4.6%) Years in practice (Mean + SD) 14.6 + 9.8 -- Area of practice/training (n, %) Public Private Both 3 (5.4%) 19 (33.9%) 34 (60.7%) 27 (61.4%) 2 (4.6%) 15 (34.1%) Year level (n, %) NS1 NS2 NS3 NS4 NS5 -- -- -- -- -- 11 (25.0%) 12 (27.2%) 6 (13.6%) 7 (15.9%) 8 (18.2%) Both SC and IC had similar findings. Consultants and residents both preferred using the microscope (SC 82.1% and 75.0%; IC 87.5% and 81.8%; consultants and residents respectively) for magnification, both groups used high speed drills more than other craniotomy equipment (SC 39.3% and 40.9%; IC 41.1% and 43.2%), and both reported an average operating time of 2-4 hours (SC 78.6% and 72.7%; IC 53.8% and 68.2%). For TS, consultants generally performed more microscopic surgeries (48.2%) while residents had more experience doing endoscopic transsphenoidal surgeries (43.1%) or both (45.5%). Consultants more frequently used the osteotome (55.3%) while residents preferred the high speed drill (77.3%). Both consultants and residents also reported an average operating time of 2-4 hours (78.6% and 77.2%, respectively). Consultants and residents had similar responses for VPS insertions. Both groups preferred to use a Hudson brace as the burr hole tool (69.6% and 77.3%), pass the shunt caudal to cranial (66.1% and 63.6%), and open the abdomen with no assistance from general surgery (96.4% and 100%). They both reported an estimated operating time of less than 2 hours (83.9% and 77.3%). For SS, both consultants and residents most frequently used the C-arm for intraoperative navigation (58.9% and 56.8%) and preferred using the microscope (62.5% and 65.9%) for magnification. Most also used bone rongeurs (76.8% and 65.9%) rather than high speed drills (23.2% and 34.1%). Majority of respondents did not commonly perform fusion procedures (69.0%) and also did not wear lead gowns during surgery (76.0%). The average estimated operating time for spine procedures by all respondents was 2-4 hours (68.0%). Pain Scores All respondents reported pain in at least one anatomic region for all five index procedures. For consultants, the greatest prevalence of pain was at the neck (SC 76.8%, IC 89.3%, TS 69.6%, VPS 33.9%, and SS 71.4%). For residents, it was at the lower back (SC 84.1%, IC 86.4%, TS 75.0%, VPS 47.7%, and SS 79.5%). Per procedure, the greatest prevalence of pain was the neck for SC (83%) and IC (92%) and the lower back for TS (72.0%), VPS (45.0%), and SS (76.0%). (Table 4) A Shapiro-Wilk test showed that both consultant and resident pain scores for all five index operations were not normally distributed. A Mann-Whitney U test was used to compare the mean pain scores per anatomic region and per procedure between consultants and residents. The mean pain scores were greater in residents than consultants across all anatomic regions and index operations (Table 4). Figure 1 uses a heat map to illustrate the distribution of the pain and their relative severity. Table 2. Operative data of consultants and residents in SC and IC Supratentorial Craniotomy (SC) Infratentorial Craniotomy (IC) Consultants (n=56) Residents (n=44) Consultants (n=56) Residents (n=44) Predominant role (n, %) Primary surgeon Assist 55 (98.2%) 1 (1.8%) 21 (47.7%) 23 (52.3%) 54 (96.4%) 2 (3.6%) 16 (36.4%) 28 (63.6%) Predominant position (n, %) Sitting Standing 27 (48.2%) 29 (51.8%) 11 (25.0%) 33 (75.0%) 19 (33.9%) 37 (66.0%) 10 (22.7%) 34 (77.3%) Magnification (n, %) None Corrective lenses Loupes Microscope 7 (12.5%) 33 (58.9%) 38 (67.9%) 46 (82.1%) 11 (25.0%) 23 (52.3%) 22 (50.0%) 33 (75.0%) 4 (7.14%) 33 (58.9%) 35 (62.5%) 49 (87.5%) 7 (15.9%) 19 (43.2%) 18 (40.9%) 36 (81.8%) Craniotomy tool (n, %) Hudson brace & Gigli wire Craniotome High speed drill 12 (21.4%) 22 (39.3%) 22 (39.3%) 12 (27.3%) 14 (31.8%) 18 (40.9%) 12 (21.4%) 21 (37.5%) 23 (41.1%) 11 (25.0%) 14 (31.8%) 19 (43.2%) Estimated length of case (n, %) Less than 2 hours 2-4 hours >4 hours 2 (3.6%) 44 (78.6%) 10 (17.8%) 1 (2.3%) 32 (72.7%) 11 (25.0%) 1 (1.8%) 30 (53.8%) 25 (44.6%) 0 (0%) 30 (68.2%) 14 (31.8%) Table 3. Operative data of consultants and residents in TS, VPS, and SS Transsphenoidal Surgery (TS) Consultants (n=56) Residents (n=44) Predominant role (n, %) Primary surgeon Assist 47 (83.9%) 9 (16.1%) 9 (20.4%) 35 (79.5%) Predominant position (n, %) Sitting Standing 9 (16.1%) 47 (83.9%) 1 (2.3%) 43 (97.7%) Type of transsphenoidal surgery Microscopic Endoscopic Both 27 (48.2%) 11 (19.6%) 18 (32.1%) 5 (11.3%) 19 (43.1%) 20 (45.5%) Sellotomy tool (n, %) Osteotome High speed drill 31 (55.3%) 25 (44.6%) 10 (22.7%) 34 (77.3%) Estimated length of case (n, %) Less than 2 hours 2-4 hours >4 hours 3 (5.4%) 44 (78.6%) 9 (16.1%) 7 (15.9%) 34 (77.2%) 3 (6.8%) Ventriculoperitoneal Shunt (VPS) Insertion Predominant role (n, %) Primary surgeon Assist 56 (100%) 0 (0%) 29 (65.9%) 15 (34.1%) Predominant position (n, %) Sitting Standing 6 (10.7%) 50 (89.3%) 4 (9.1%) 40 (90.9%) Magnification (n, %) None Corrective lenses Loupes 18 (32.1%) 33 (58.9%) 9 (16.1%) 22 (50.0%) 21 (47.7%) 2 (4.5%) Burr hole tool (n, %) Hudson brace Craniotome High speed drill 39 (69.6%) 10 (17.9%) 7 (12.5%) 34 (77.3%) 8 (18.2%) 2 (4.5%) Shunt passing (n, %) Cranial to caudal Caudal to cranial 19 (33.9%) 37 (66.1%) 16 (36.4%) 28 (63.6%) Abdominal opening (n, %) By Neurosurgery By General surgery 54 (96.4%) 2 (3.6%) 44 (100%) 0 (0%) Estimated length of case (n, %) Less than 2 hours 2-4 hours >4 hours 47 (83.9%) 9 (16.1%) 0 (0%) 34 (77.3%) 10 (22.7%) 0 (0%) Spine surgery (SS) Predominant role (n, %) Primary surgeon Assist 51 (91.1%) 5 (8.9%) 11 (25.0%) 33 (75.0%) Predominant position (n, %) Sitting Standing 56 (100%) 0 (0%) 41 (93.2%) 3 (6.8%) Intraoperative navigation (n, %) X-ray C-arm Stereotaxy/image guidance O-arm None 18 (32.1%) 33 (58.9%) 1 (1.8%) 0 (0%) 4 (7.1%) 17 (38.6) 25 (56.8) 1 (2.3%) 1 (2.3%) 0 (0%) Magnification (n, %) None Corrective lenses Loupes Microscope 3 (5.4%) 30 (53.6%) 33 (58.9%) 35 (62.5%) 10 (22.7%) 18 (40.9%) 15 (34.1%) 29 (65.9%) Craniotomy tool (n, %) Bone rongeur High speed drill 43 (76.8%) 13 (23.2%) 29 (65.9%) 15 (34.1%) Commonly perform fusion (n, %) Yes No 15 (26.8%) 41 (73.2%) 16 (36.4%) 28 (63.6%) Used lead gown intraop (n, %) Yes No 9 (16.1%) 47 (83.9%) 15 (34.1%) 29 (65.9%) Estimated length of case (n, %) Less than 2 hours 2-4 hours >4 hours 3 (5.4%) 36 (64.2%) 17 (30.4%) 4 (9.1%) 32 (72.7%) 8 (18.2%) Table 4. Statistical analysis between pain scores of consultants and residents for SC, IC, TS, VPS, and SS Supratentorial Craniotomy (SC) Prevalence of pain (n, %) Pain scores (n, %) Consultants (n=56) Residents (n=44) Consultants (n=56) Residents (n=44) p-value (Mann-Whitney U) Head 15 (26.8%) 35 (79.5%) 0.6 + 1.5 2.7 + 2.3 p=3.14x10 -7 (U=693.0) Eyes 17 (30.4%) 29 (65.9%) 0.5 + 1.1 2.1 + 2.4 p=7.61x10 -5 (U=796.0) Teeth 4 (7.1%) 5 (11.4%) 0.1 + 0.3 0.3 + 1.2 p=0.148 (U=1056.5) Neck 43 (76.8%) 40 (90.9%) 2.3 + 2.2 4.0 + 2.7 p=0022 (U=810) Shoulder 46 (82.1%) 34 (77.3%) 2.5 + 2.1 3.5 + 2.6 p=0.0276 (U=933.5) Upper back 41 (73.2%) 38 (86.4%) 2.1 + 2.1 3.4 + 2.4 p=0.0053 (U=850.0) Elbows 15 (26.8%) 18 (40.9%) 0.6 + 1.4 1.5 + 2.2 p=0.0504 (U=1012.5) Wrist/hand 29 (51.8%) 32 (72.7%) 1.3 + 1.8 2.4 + 2.4 p=0.0078 (U=877.5) Lower back 42 (75.0%) 37 (84.1%) 2.4 + 2.4 3.2 + 2.3 p=0.0343 (U=946.5) Hips/Thigh 16 (28.6%) 20 (45.5%) 0.8 + 1.5 1.7 + 2.3 p=0.0569 (U=1012.5) Knees 19 (33.9%) 25 (56.8%) 0.9 + 1.2 1.9 + 2.3 p=0.0132 (U=925.5) Ankles/Feet 21 (37.5%) 30 (68.1%) 1.1 + 1.8 2.6 + 2.5 p=0.0038 (U=856.0) TOTAL Pain Score 1.3 + 1.9 2.4 + 2.5 p=0.107 (U=54,851.5) Infratentorial Craniotomy (IC) Prevalence of pain (n, %) Pain scores (n, %) Consultants (n=56) Residents (n=44) Consultants (n=56) Residents (n=44) p-value (Mann-Whitney U) Head 20 (35.7%) 35 (79.5%) 0.8 + 1.7 2.7 + 2.4 p=0.00021 (U=892.5) Eyes 17 (30.4%) 29 (65.9%) 0.5 + 1.1 2.2 + 2.4 p=0.00114 (U=981.0) Teeth 5 (8.9%) 8 (18.2%) 0.2 + 0.7 0.5 + 1.5 p=0.2421 (U=1448.0) Neck 50 (89.3%) 42 (95.4%) 2.7 + 2.2 4.2 + 2.6 p=0.00324 (U=833.5) Shoulder 50 (89.3%) 38 (86.4%) 2.6 + 2.3 3.5 + 2.6 p=0.1144 (U=1031.0) Upper back 43 (76.8%) 39 (88.6%) 2.2 + 2.3 3.7 + 2.6 p=0.0336 (U=1092.0) Elbows 17 (30.4%) 20 (45.5%) 0.7 + 1.4 1.4 + 2.0 p=0.0890 (U=1265.0) Wrist/hand 26 (46.4%) 29 (65.9%) 1.3 + 2.0 2.3 + 2.4 p=0.0150 (U=1078.5) Lower back 40 (71.4%) 38 (86.4%) 2.3 + 2.3 3.0 + 2.3 p=0.1088 (U=1174.0) Hips/Thigh 19 (33.9%) 21 (47.7%) 0.8 + 1.5 1.6 + 2.1 p=0.0901 (U=1261.0) Knees 23 (41.1%) 23 (52.3%) 1.0 + 1.6 1.8 + 2.2 p=0.0289 (U=889.0) Ankles/Feet 23 (41.1%) 28 (63.6%) 1.1 + 1.8 2.0 + 2.0 p=0.0088 (U=862.0) TOTAL Pain Score 1.4 + 2.0 2.4 + 2.5 p=1.28x10 -8 (U=26284.5) Transsphenoidal Surgery (TS) Prevalence of pain (n, %) Pain scores (n, %) Consultants (n=56) Residents (n=44) Consultants (n=56) Residents (n=44) p-value (Mann-Whitney U) Head 17 (30.4%) 25 (56.8%) 0.7 + 1.3 1.8 + 2.4 p=0.00094 (U771.0) Eyes 18 (32.1%) 22 (50.0%) 0.6 + 1.1 1.6 + 2.3 p=0.03024 (U1061.0) Teeth 5 (8.9%) 5 (11.4%) 0.1 + 0.4 0.4 + 1.3 p=0.0762 (U1006.5) Neck 39 (69.6%) 26 (59.1%) 1.9 + 2.1 2.4 + 2.6 p=0.687 (U1175.0) Shoulder 37 (66.1%) 27 (61.4%) 1.9 + 2.1 2.5 + 2.6 p=0.368 (U1065.0) Upper back 36 (64.3%) 30 (68.2%) 2.0 + 2.4 2.5 + 2.3 p=0.176 (U1003.0) Elbows 19 (33.9%) 18 (40.9%) 0.8 + 1.4 1.5 + 2.3 p=0.219 (U963.0) Wrist/hand 22 (39.3%) 23 (52.3%) 1.1 + 1.6 1.7 + 2.4 p=0.134 (U984.5) Lower back 39 (69.6%) 33 (75.0%) 2.4 + 2.5 2.5 + 2.3 p=0.737 (U1184.0) Hips/Thigh 23 (41.1%) 18 (40.9%) 1.3 + 2.1 1.2 + 1.9 p=0.886 (U1143.0) Knees 23 (41.1%) 20 (45.5%) 1.2 + 1.8 1.3 + 2.2 p=0.735 (U1254.5) Ankles/Feet 21 (37.5%) 26 (59.1%) 1.1 + 1.8 1.7 + 2.0 p=0.020 (U980.0) TOTAL Pain Score 1.3 + 1.9 1.8 + 2.3 p=2.17x10 -5 (U18537.5) Ventriculoperitoneal Shunt Insertion (VPS) Prevalence of pain (n, %) Pain scores (n, %) Consultants (n=56) Residents (n=44) Consultants (n=56) Residents (n=44) p-value (Mann-Whitney U) Head 8 (14.3%) 18 (40.9%) 0.2 + 0.5 0.8 + 1.5 p=0.0041 (U900.5) Eyes 8 (14.3%) 14 (31.8%) 0.2 + 0.5 0.7 + 1.7 p=0.0287 (U1009.0) Teeth 2 (3.6%) 5 (11.4%) 0.04 + 0.2 0.3 + 1.1 p=0.0387 (U1022.5) Neck 19 (33.9%) 17 (38.6%) 0.6 + 1.0 1.4 + 2.6 p=0.425 (U821.5) Shoulder 21 (37.5%) 21 (47.7%) 0.7 + 1.1 1.6 + 2.4 p=0.120 (U1013.0) Upper back 19 (33.9%) 24 (54.5%) 0.6 + 1.0 1.6 + 2.4 p=0.015 (U965.0) Elbows 15 (26.8%) 18 (40.9%) 0.4 + 0.7 1.0 + 2.0 p=0.104 (U1166.0) Wrist/hand 15 (26.8%) 23 (52.3%) 0.5 ­ + 1.2 1.6 + 2.3 p=0.0035 (U875.0) Lower back 24 (42.9%) 21 (47.7%) 0.9 + 1.3 1.4 + 2.3 p=0.349 (U1108.0) Hips/Thigh 11 (19.6%) 14 (31.8%) 0.4 + 1.0 0.6 + 1.5 p=0.176 (U1004.5) Knees 12 (21.4%) 14 (31.8%) 0.4 + 0.9 0.9 + 2.1 p=0.158 (U998.0) Ankles/Feet 12 (21.4%) 18 (40.9%) 0.4 + 1.2 1.2 + 2.2 p=0.0216 (U938.5) TOTAL Pain Score 0.4 + 1.0 1.1 + 2.1 p=0.168 (U34157.0) Spine Surgery (SS) Prevalence of pain (n, %) Pain scores (n, %) Consultants (n=56) Residents (n=44) Consultants (n=56) Residents (n=44) p-value (Mann-Whitney U) Head 16 (28.6%) 28 (63.6%) 0.6 + 1.3 1.9 + 2.1 p=5.0x10 -5 (U697.5) Eyes 15 (26.8%) 19 (43.2%) 0.4 + 0.7 1.3 + 2.0 p=0.0044 (U882.0) Teeth 4 (7.1%) 5 (11.4%) 0.1 + 0.6 0.3 + 1.2 p=0.0118 (U1114.5) Neck 40 (71.4%) 35 (79.5%) 2.1 + 1.9 3.3 + 2.7 p=0.0046 (U863.5) Shoulder 36 (64.3%) 32 (72.7%) 1.8 + 2.0 3.1 + 2.8 p=0.0030 (U827.5) Upper back 40 (71.4%) 30 (68.2%) 1.9 + 1.9 3.2 + 2.8 p=0.0049 (U759.0) Elbows 18 (32.1%) 20 (45.5%) 0.8 + 1.4 1.6 + 2.3 p=0.0189 (U974.0) Wrist/hand 30 (53.6%) 29 (65.9%) 1.4 + 1.8 2.8 + 2.8 p=0.0032 (U915.0) Lower back 41 (73.2%) 35 (79.5%) 2.4 + 2.2 3.0 + 2.6 p=0.094 (U873.0) Hips/Thigh 27 (48.2%) 23 (52.3%) 1.2 + 1.7 1.8 + 2.3 p=0.121 (U1221.5) Knees 23 (41.1%) 21 (47.7%) 1.0 + 1.7 1.7 + 2.3 p=0.091 (U1210.0) Ankles/Feet 21 (37.5%) 28 (63.6%) 1.0 + 1.7 2.2 + 2.3 p=0.0017 (U775.5) TOTAL Pain Score 1.2 + 1.8 2.2 + 2.5 p=7.83x10 -5 (U22662.0) SC, IC, and SS were associated with the highest pain scores for both consultants and residents, especially at the neck (SC 2.3 ± 2.2 vs 4.0 ± 2.7, IC 2.7 ± 2.2 vs 4.2 ± 2.6, SS 2.1 ± 1.9 vs 3.3 ± 2.7), shoulder (SC 2.5 ± 2.1 vs 3.5 ± 2.6, IC 2.6 ± 2.3 vs 3.5 ± 2.6, SS 1.8 ± 2.0 vs 3.1 ± 2.8), upper back (SC 2.1 ± 2.1 vs 3.4 ± 2.4, IC 2.2 ± 2.3 vs 3.7 ± 2.6, SS 1.9 ± 1.9 vs 3.2 ± 2.8), wrists (SC 1.3 ± 1.8, IC 1.3 ± 2.0 vs 2.3 ± 2.4, SS 1.4 ± 1.8 vs 2.8 ± 2.8), and lower back (SC 2.4 ± 2.4 vs 3.2 ± 2.3, IC 2.3 ± 2.3 vs 3.0 ± 2.3, SS 2.4 ± 2.2 vs 3.0 ± 2.6). Total mean pain scores were significantly different between IC (1.4 ± 2.0 vs 2.4 ± 2.5, p<0.0001), TS (1.3 ± 1.9 vs 1.8 ± 2.3, p<0.0002), and SS (1.2 ± 1.8 vs 2.2 ± 2.5, p<0.0007). Subgroup analysis of resident pain scores between surgical roles (assist vs primary surgeon) showed higher mean pain scores as the assist for SC (2.7 vs 2.1, p=0.004), IC (2.6 vs 2.1, p=0.004), VPS (1.3 vs 0.9, p=0.003), and SS (2.2 vs 2.1, p=0.004). All four were statistically significant. Top 3 Procedures that Caused the Most Work-Related Pain For consultants, the top three procedures that caused the most work-related pain were lengthy and/or complex brain tumor surgery (n=61), especially infratentorial, skull base, and cerebellopontine angle tumors (Table 5). This was followed by spine cases (n=39), mainly laminectomy with or without fusion procedures, and transsphenoidal tumor excision (n=21). On the other hand, the residents’ top three most painful procedures were spine surgery (n=29), infratentorial (n=28), and supratentorial (n=15) craniotomy. Table 5. Procedures that cause the most work-related pain (consultants and residents) CONSULTANTS RESIDENTS Procedure Number of responses Procedure Number of responses Brain tumor surgery Infratentorial Skull base Cerebellopontine angle Others (lengthy, complex, pineal) 61 27 10 8 16 Spine surgery 29 Spine surgery 39 Infratentorial craniotomy, not specified 28 Transsphenoidal tumor excision 21 Supratentorial craniotomy, not specified 15 Vascular neurosurgery (aneurysm clipping, bypass, AVM) 14 Tumor excision 12 Supratentorial craniotomy, not specified 9 Transsphenoidal tumor excision 9 VPS insertion 3 Vascular neurosurgery 7 Decompressive hemicraniectomy 2 Others (VPS insertion, skull base surgery, etc.) 15 * AVM - arteriovenous malformation, VPS - ventriculoperitoneal shunt Intraoperative and Behavioral Responses to Pain To alleviate the pain, consultants and residents responded similarly (Figures 2 and 3). The most common intraoperative responses were to stretch (n=86), change the height of the surgical field (n=61), change the angulation of the microscope (n=58), and sit down (n=57). Fifty-five respondents used specialized equipment (arm rests, compression stockings, ergonomic equipment), 45 distracted themselves by playing music or chatting with people, 42 took a break, and 35 ignored the pain. The most common behavioral response to work-related musculoskeletal pain was negative (n=51), namely, increased irritability, decreased patience, and decreased willingness to teach others. Others exercised more (n=42), while some adjusted their operative schedule to allow rest (n=33). Only 31 respondents sought medical consult and 15 underwent physical therapy, acupuncture, yoga, and other alternative forms of treatment. Twelve respondents spent time away from neurosurgery, with three considering early retirement. DISCUSSION The results of our survey showed the presence of work-related musculoskeletal pain for both consultants and residents across the five index operations. The anatomic regions that were most affected were the neck, shoulders, upper back, wrists, and lower back, which were also consistent with the existing literature [ 2 – 6 ]. Among the index operations, SC, IC, and SS had the highest pain scores, particularly among residents. Consultants had lower pain scores across all anatomic regions and index operations compared to residents. It has been reported that the prevalence of neck pain in the general population was 20%; shoulder pain, 24.7%-49%; wrist pain, 6%; and lower back pain, 7.8% [ 4 – 6 , 16 – 17 ]. Our findings showed a higher prevalence of pain in these anatomic areas among neurosurgeons, likely due to the physically demanding nature of the work. Our cohort had a high prevalence of upper back pain, an area which was not commonly reported in population studies of pain, except for a Finnish study that reported a 17% prevalence [ 18 ]. Craniotomies, both supra- and infratentorial, were associated with the highest pain scores in our cohort. This may be reflective of the neurosurgical practice in the Philippines, where the majority of procedures performed were cranial operations [ 19 ]. Thus, respondents may have reported more pain with craniotomy because this was the procedure they perform the most. Neurosurgeons have to adjust to the different positions required for these procedures, but inexperienced residents may not have learned to adapt, resulting in uncomfortable operating positions and increased pain. Lack of familiarity with microscope use, longer standing times, and poor operating posture could also have contributed to the increased pain scores of residents [ 5 , 7 ]. Spine procedures were responsible for much of the work-related musculoskeletal pain in our study and in published literature. Worldwide, spine surgeons have reported an increase in the prevalence of cervical and lumbar radiculopathy and rotator cuff disease, for which 4.6–7.1% of surgeons with these conditions underwent surgery [ 6 ]. Majority of our respondents used bone rongeurs, and it has been found that repetitive use of hand instruments such as rongeurs during laminectomies can lead to wrist pain [ 7 ]. The use of lead gowns and performing fusion procedures can also cause increased strain especially on the upper and lower back [ 5 – 8 ]. Relative unfamiliarity with microscope use (for residents) and the greater degree of cervical spine flexion when operating while standing may contribute to head and neck pain [ 20 ]. Similar to the craniotomies, residents reported more pain than consultants [ 5 , 7 ]. Comparison between Consultants and Residents In our study, the consultants had lower mean pain scores than residents, despite being older and having more medical and musculoskeletal comorbidities. However, they have been in neurosurgical practice for a longer period of time, and devoted more time to exercise. This suggests that inexperience and lack of exercise may be important factors contributing to work-related musculoskeletal pain. Consultants, who have a mean tenure of 14.6 years, could have developed their technique over time to minimize intraoperative pain. They also have more control over their schedule and more time to rest, compared to residents. There are conflicting findings regarding the relationship of tenure to pain. One author reported that neurosurgery trainees and consultants who were more than 11 years into their practice had comparable pain prevalence [ 2 ], while another wrote that tenure of more than 15 years was associated with musculoskeletal pain among neurosurgery consultants [ 4 ]. Residents were more likely to be an assist in the five index procedures, and the pain scores as assist were higher than as primary surgeon. This was logical because the operating field would be biased ergonomically for the primary surgeon. A study on laparoscopic surgery showed that assists had similar and occasionally higher levels of muscle activation compared to primary surgeons, which can lead to ergonomic stress [ 21 ]. Other anatomic regions that were significantly more painful for residents than consultants include the head, eyes, and ankles/feet. One reason may be the lack of experience with magnification equipment (loupes or microscope) causing headache and eye strain. Another possible reason may be the general workload, stress, and lack of sleep associated with residency training, predisposing the resident to headache and eye pain. Younger residents may not be used to lengthy operations, especially in a standing position, leading to pain in the lower extremities. Prolonged standing has been correlated with increased musculoskeletal pain [ 2 – 6 ]. Behavioral Response to Pain The most common intraoperative responses were adjusting body position or the ergonomics of the surgical field. The most common behavioral response (increased irritability, decreased patience) suggests work-related musculoskeletal pain causes additional social strain that negatively affects the workplace environment [ 9 – 11 ]. Only 9% of respondents considered spending time away from neurosurgery, and 3% considered early retirement. In Ho et al.’s study, 1 in 10 otorhinolaryngologists (10%) considered early retirement [ 22 ]. Other authors reported higher numbers, with 30-31.9% of respondents taking time off or retiring due to the work-related musculoskeletal pain [ 6 , 10 ]. Recommendations Given our findings, there is a need to address work-related musculoskeletal pain among neurosurgery consultants and residents. Ergonomic training and educational programs geared towards their health may be instituted to promote better well-being. Physical therapy, exercise, and wellness programs may also be started in order to improve neurosurgeon stamina and tolerance. Adjusting operating schedules to allot time for rest may be helpful in reducing pain. In addition, securing ergonomic operating room equipment and taking a mandatory break during long surgical procedures may be of benefit. Limitations The study has several limitations. First, as the intent of this survey was to obtain an overview of symptom prevalence and their associated behaviors by neurosurgeons in the Philippines, there was an appreciable selection bias generated by the distribution of the survey and voluntary survey participation. Second, respondents were asked to remember details regarding the onset, degree, and frequency of their symptoms, which was subject to recall bias. Third, workload and stress outside of surgery were not part of the scope of the study, but they may have contributed to the overall work-related musculoskeletal pain of the respondent. Finally, the survey instrument included open-ended responses (top 3 procedures that caused the most pain) that required interpretation and categorization on a case-by-case basis. They were summarized at the end of the results to the best of our capabilities. CONCLUSION Both neurosurgery consultants and residents reported work-related musculoskeletal pain. Residents, who are younger and have fewer comorbidities but less experience and less exercise, reported more pain compared to the consultants. The anatomic regions that were most affected were the neck, shoulders, upper back, wrists, and lower back. The procedures with the highest pain scores were SC, IC, and SS, which may be related to the scope of neurosurgery practice in the Philippines. As the first local study on work-related musculoskeletal pain in the Philippine neurosurgical field, this descriptive study contributes to a growing body of literature interested in investigating and promoting policies that can improve the well-being of neurosurgeons, ultimately improving neurosurgical care. Abbreviations AFNI Academy of Filipino Neurosurgeons, Incorporated PANSR Philippine Association of Neurosurgical Residents SC Supratentorial craniotomy IC Infratentorial craniotomy TS Transsphenoidal surgery VPS Ventriculoperitoneal shunt SS Spine surgery Declarations Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Competing Interests The authors have no relevant financial or non-financial interests to disclose. Author Contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Sean Kendrich N. Cua, MD, Juan Silvestre G. Pascual, MD, Mary Angeline Luz U. Hernandez, MD, Eric Dennis C. Legaspi, MD, Kathleen Joy O. Khu, MD. The first draft of the manuscript was written by Sean Kendrich N. Cua, MD and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Ethics Approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the University of the Philippines Manila Research Ethics Board (UPMREB) Review Panel 4 (10 June 2024, 2024-0432-01). Consent to Participate Informed consent was obtained from all individual participants included in the study. Consent to Publish The authors affirm that human research participants provided informed consent for publication of the data provided in the study. CRediT Author Statement: Conceptualization: Sean Kendrich N. Cua, MD, Juan Silvestre G. Pascual, MD, Mary Angeline Luz U. Hernandez, MD, Eric Dennis C. Legaspi, MD, Kathleen Joy O. Khu, MD; Resource: Sean Kendrich N. Cua, MD, Juan Silvestre G. Pascual, MD, Mary Angeline Luz U. Hernandez, MD, Eric Dennis C. Legaspi, MD, Kathleen Joy O. Khu, MD; Methodology: Sean Kendrich N. Cua, MD, Juan Silvestre G. Pascual, MD, Kathleen Joy O. Khu, MD; Data Curation: Sean Kendrich N. Cua, MD, Juan Silvestre G. Pascual, MD; Formal analysis: Sean Kendrich N. Cua, MD, Juan Silvestre G. Pascual, MD; Writing – Original Draft Preparation: Sean Kendrich N. Cua, MD, Kathleen Joy O. Khu; Writing – review and editing: Sean Kendrich N. Cua, MD, Juan Silvestre G. Pascual, MD, Kathleen Joy O. Khu, MD; Visualization: Sean Kendrich N. Cua, MD, Juan Silvestre G. Pascual, MD, Kathleen Joy O. Khu, MD; Validation: Mary Angeline Luz U. Hernandez, MD; Supervision: Eric Dennis C. Legaspi, MD, Kathleen Joy O. Khu, MD; Project Administration: Kathleen Joy O. Khu, MD References Epstein S, Sparer EH, Tran BN, et al. (2018) Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists: A Systematic Review and Meta-analysis. JAMA Surg . 153(2):e174947. doi:10.1001/jamasurg.2017.4947 Mavrovounis G, Meling TR, Lafuente J, Fountas KN, Demetriades AK. (2021) Postural ergonomics and work-related musculoskeletal disorders in neurosurgery: lessons from an international survey. Acta Neurochir (Wien) 163(6):1541-1552. doi:10.1007/s00701-021-04722-5 McQuivey KS, Deckey DG, Christopher ZK, et al. (2021) Surgical Ergonomics and Musculoskeletal Pain in Orthopaedic Surgery Residents: A Multicenter Survey Study. J Am Acad Orthop Surg Glob Res Rev . 5(3):e20.00119. Published 2021 Mar 11. doi:10.5435/JAAOSGlobal-D-20-00119 Gadjradj PS, Ogenio K, Voigt I, Harhangi BS. (2020) Ergonomics and Related Physical Symptoms Among Neurosurgeons. World Neurosurg . 134:e432-e441. doi:10.1016/j.wneu.2019.10.093 Lavé A, Gondar R, Demetriades AK, Meling TR. (2020) Ergonomics and musculoskeletal disorders in neurosurgery: a systematic review. Acta Neurochir (Wien) . 162(9):2213-2220. doi:10.1007/s00701-020-04494-4 Auerbach JD, Weidner ZD, Milby AH, Diab M, Lonner BS. (2011) Musculoskeletal disorders among spine surgeons: results of a survey of the Scoliosis Research Society membership. Spine (Phila Pa 1976) . 36(26):E1715-E1721. doi:10.1097/BRS.0b013e31821cd140 Schupper AJ, Hrabarchuk EI, McCarthy L, Hadjipanayis CG. (2023) Improving Surgeon Well-Being: Ergonomics in Neurosurgery. World Neurosurg . 175:e1220-e1225. doi:10.1016/j.wneu.2023.04.102 Wyatt RW, Lin CC, Norheim EP, Przepiorski D, Navarro RA. (2020) Occupation-related Cervical Spine Disease in Orthopaedic Surgeons. J Am Acad Orthop Surg . 28(17):730-736. doi:10.5435/JAAOS-D-19-00834 Svebak S, Halvari H. (2018) Sickness Absence due to Chronic Musculoskeletal Pain: The Exploration of a Predictive Psychological Model Including Negative Moods, Subjective Health and Work Efficacy in an Adult County Population (The HUNT Study). Eur J Psychol . 14(2):373-385. Published 2018 Jun 19. doi:10.5964/ejop.v14i2.1470 Wright ME. (1997) Long-term sickness absence in an NHS teaching hospital. Occup Med (Lond) . 47(7):401-406. doi:10.1093/occmed/47.7.401 de Paiva LG, Dalmolin GL, Dos Santos WM. (2021) Absenteeism-disease in health care workers in a hospital context in southern Brazil. Rev Bras Med Trab . 18(4):399-406. Published 2021 Mar 3. doi:10.47626/1679-4435-2020-521 Hafner ND, Milek DM, Fikfak MD. (2018) Hospital Staff's Risk of Developing Musculoskeletal Disorders, Especially Low Back Pain. Zdr Varst . 57(3):133-139. Published 2018 Jun 21. doi:10.2478/sjph-2018-0017 Wohlauer M, Coleman DM, Sheahan MG, et al. (2021) Physical pain and musculoskeletal discomfort in vascular surgeons. J Vasc Surg . 73(4):1414-1421. doi:10.1016/j.jvs.2020.07.097 Borg G. (1990) Psychophysical scaling with applications in physical work and the perception of exertion. Scand J Work Environ Health . 16 Suppl 1:55-58. doi:10.5271/sjweh.1815 Academy of Filipino Neurosurgeons, Inc. (2024) Landing Page - Academy of Filipino Neurosurgeons, Inc. Academy of Filipino Neurosurgeons, Inc. Published May 17, 2024. Accessed October 21, 2024. https://www.afninc.org GBD 2021 Low Back Pain Collaborators. (2021) Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study Lancet Rheumatol . 2023;5(6):e316-e329. Published 2023 May 22. doi:10.1016/S2665-9913(23)00098-X Ferguson R, Riley ND, Wijendra A, Thurley N, Carr AJ, Bjf D. (2019) Wrist pain: a systematic review of prevalence and risk factors- what is the role of occupation and activity?. BMC Musculoskelet Disord . 20(1):542. Published 2019 Nov 14. doi:10.1186/s12891-019-2902-8 Niemeläinen R, Videman T, Battié MC. (2006) Prevalence and characteristics of upper or mid-back pain in Finnish men. Spine (Phila Pa 1976) . 31(16):1846-1849. doi:10.1097/01.brs.0000226022.05420.1f Baticulon RE, Lucena LLN, Gimenez MLA, Sabalza MN, Soriano JA. (2024) The Neurosurgical Workforce of the Philippines. Neurosurgery . 94(1):202-211. doi:10.1227/neu.0000000000002630 Tanaka SA, Patel NM, Murthy AS. (2020) No Longer a Pain in the Neck: Use of Operating Microscope for Palatoplasty. Plast Reconstr Surg Glob Open . 8(10):e3196. Published 2020 Oct 29. doi:10.1097/GOX.0000000000003196 Zihni AM, Cavallo JA, Ray S, Ohu I, Cho S, Awad MM. (2016) Ergonomic analysis of primary and assistant surgical roles. J Surg Res . 203(2):301-305. doi:10.1016/j.jss.2016.03.058 Ho TT, Hamill CS, Sykes KJ, Kraft SM. (2018) Work-related musculoskeletal symptoms among otolaryngologists by subspecialty: A national survey. Laryngoscope . 128(3):632-640. doi:10.1002/lary.26859 Additional Declarations No competing interests reported. Supplementary Files APPENDIXA.docx Cite Share Download PDF Status: Published Journal Publication published 10 Jan, 2026 Read the published version in Neurosurgical Review → Version 1 posted Editorial decision: Revision requested 13 Sep, 2025 Reviews received at journal 15 Aug, 2025 Reviews received at journal 12 Aug, 2025 Reviews received at journal 10 Aug, 2025 Reviewers agreed at journal 05 Aug, 2025 Reviewers agreed at journal 05 Aug, 2025 Reviews received at journal 03 Aug, 2025 Reviewers agreed at journal 03 Aug, 2025 Reviewers agreed at journal 03 Aug, 2025 Reviewers invited by journal 03 Aug, 2025 Editor assigned by journal 03 Aug, 2025 Submission checks completed at journal 27 Jun, 2025 First submitted to journal 24 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6966022","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":496204053,"identity":"8d289308-ead0-4f51-8a03-17fc350dad8b","order_by":0,"name":"Sean Kendrich Cua","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuUlEQVRIiWNgGAWjYNACAxswJQHECURqKUgjWcuHwyRokZ/d/Ezih8H5xO0MzAdv8zDcySOoxeDOMTPJHoPbiTsb2JKteRieFRPWIpHDJsED1LLhAI+ZNA/D4cQGgg6bkcMm+cfgHFAL/zfitDDcyGGT5jE4ALKFjTgtBjfSjK1lDJKNdzazGVvOMXhGjMOSH95888dOdjt788MbbyruEOEwuHXMYPIA0RqAiiEUKVpGwSgYBaNgpAAALIg77wM8O+wAAAAASUVORK5CYII=","orcid":"","institution":"University of the Philippines Manila","correspondingAuthor":true,"prefix":"","firstName":"Sean","middleName":"Kendrich","lastName":"Cua","suffix":""},{"id":496204054,"identity":"a01af552-874e-42a2-9f03-e33297cb1955","order_by":1,"name":"Juan Silvestre Pascual","email":"","orcid":"","institution":"Philippine General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"Silvestre","lastName":"Pascual","suffix":""},{"id":496204055,"identity":"4a7db406-950b-4968-b966-0647408761c9","order_by":2,"name":"Mary Angeline Luz Hernandez","email":"","orcid":"","institution":"Philippine General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mary","middleName":"Angeline Luz","lastName":"Hernandez","suffix":""},{"id":496204056,"identity":"fdc93f2c-465b-47eb-8c78-240c588d76df","order_by":3,"name":"Eric Dennis Legaspi","email":"","orcid":"","institution":"Philippine General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Eric","middleName":"Dennis","lastName":"Legaspi","suffix":""},{"id":496204057,"identity":"d054683a-ce91-444c-a6a3-a6855ca11929","order_by":4,"name":"Kathleen Joy Khu","email":"","orcid":"","institution":"Philippine General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kathleen","middleName":"Joy","lastName":"Khu","suffix":""}],"badges":[],"createdAt":"2025-06-24 13:08:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6966022/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6966022/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10143-025-04017-8","type":"published","date":"2026-01-10T15:58:19+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88516804,"identity":"3077ea3b-c1da-47da-8c2d-0db3420dc646","added_by":"auto","created_at":"2025-08-07 09:05:21","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":287970,"visible":true,"origin":"","legend":"\u003cp\u003eHeat map describing the results of the pain scores (Mean + SD) among the five index operations. Bold values have statistically significant differences in the Mann-Whitney U test\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6966022/v1/5f76bbd50769d1997ae5dc08.png"},{"id":88516803,"identity":"265b8ddb-c4e5-4068-943b-c0b68e4847ab","added_by":"auto","created_at":"2025-08-07 09:05:21","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":94208,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative responses to work-related musculoskeletal pain\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6966022/v1/2cd903e9ccad4518aeb6394f.png"},{"id":88516806,"identity":"c324c240-9005-4df4-98ef-eee34bd79f7d","added_by":"auto","created_at":"2025-08-07 09:05:21","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":180324,"visible":true,"origin":"","legend":"\u003cp\u003eBehavioral responses to work-related musculoskeletal pain\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6966022/v1/22ba8b5633c597ded4e254f3.png"},{"id":100069992,"identity":"cc7e4aff-27bf-4b7c-af63-dc6f8b84177c","added_by":"auto","created_at":"2026-01-12 16:15:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1916893,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6966022/v1/86184931-d26c-4eed-b314-4e50142d5b22.pdf"},{"id":88516816,"identity":"815bd9a4-f5fb-4c67-89ee-22f5fe6c5b79","added_by":"auto","created_at":"2025-08-07 09:05:21","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1005663,"visible":true,"origin":"","legend":"","description":"","filename":"APPENDIXA.docx","url":"https://assets-eu.researchsquare.com/files/rs-6966022/v1/e0d5542040a12f4d1b24d9cd.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of work-related musculoskeletal pain among neurosurgeons and trainees in the Philippines","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eAmong health care workers, procedural medical specialists are more commonly at risk for developing musculoskeletal pain due to the nature of their work [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These injuries are classified as \u0026ldquo;work-related musculoskeletal disorders,\u0026rdquo; which have gained an increased level of interest over the past few years due to their impact on both surgeons and patient care [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Neurosurgeons, in particular, are prone to develop acute or chronic injuries given the physical strain and long hours of their procedures [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGadjradj et al. reported that 73.6% of all neurosurgeons experience work-related musculoskeletal concerns, particularly in three procedures: lumbar discectomy, ventriculoperitoneal shunt (VPS) insertion, and endoscopic third ventriculostomy. These were identified to cause neck, shoulder, and back complaints primarily [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Most neurosurgeons also perform craniotomies and other spine surgeries, which have been reported to cause pain in the same anatomic regions, as well as the elbows and wrists [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Most of the pain was attributed to the repetitive use of bone rongeurs, high speed drills, and VPS passers, as well as the concentrated tension in keeping microsurgical tools steady for the duration of the surgery [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. All of these may contribute to an increased risk of repetitive strain injury, carpal tunnel syndrome, and wrist or hand dysfunction [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn addition to the instruments used in neurosurgery, magnification is a mainstay in most cranial and spinal procedures, and may contribute to work-related musculoskeletal pain. It comes in the form of surgical loupes, microscopes, and endoscopes. Although they are beneficial in providing ample visualization of the surgical field, prolonged use has been reported to lead to spinal stiffness, neck strain, and eye strain [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The use of lead gowns or aprons in spinal surgery, which may weigh up to 5\u0026ndash;8 kg, have also led to increased fatigue and strain on the muscles of the upper and lower back [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThese disorders may contribute to a decrease in the quality of the neurosurgeon\u0026rsquo;s performance, decrease in general well-being, and an increase in occupational burnout and mental health issues [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. There has also been an increase in absenteeism of doctors, leading to decreased career longevity. Overall, these disorders may also cause a general decrease in the quality of neurosurgical patient care [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGiven this, the investigators aimed to determine the work-related musculoskeletal pain and associated problems neurosurgeons (consultants) and neurosurgical trainees (residents) in the Philippines experience. This was done by performing an online survey among the members of the Association of Filipino Neurosurgeons Inc. (AFNI) and Philippine Association of Neurosurgical Residents (PANSR). This information will be beneficial in determining the possible areas of ergonomic improvement for neurosurgeons, as well as offering insights to policies that may be formed to help improve the general well-being of the neurosurgeons in our country.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eThis was a cross-sectional study utilizing an online survey of consultants and residents who are members of AFNI and PANSR, respectively. The survey was developed and adapted to our setting by the study authors. This was based on different validated and published literature as well as a focus group discussion conducted among consultants and residents of different ages and year levels in the authors\u0026rsquo; institution [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Pilot testing was performed in the same setting to determine content, construct, and face validity of the survey. The survey was revised and streamlined based on comments of participants and observations of the study authors during the pilot testing. The final 64-item survey included questions on the following: demographics, pertinent past medical history, procedures performed and regularly assisted by the surgeon, anatomic distribution of pain (head, eyes, teeth, neck, shoulders, upper back, elbows, wrist/hand, lower back, hips/thighs, knees, and ankles/feet) based on five index operations, and behaviors and responses of the surgeon to address the work-related musculoskeletal pain [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The five index operations were supratentorial craniotomy (SC), infratentorial craniotomy (IC), transsphenoidal surgery (TS), ventriculoperitoneal shunt insertion (VPS), and spine surgery (SS). Pain was measured using the Borg 0\u0026ndash;10 scale [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. A sample of the data collection form can be seen in Appendix 1.\u003c/p\u003e\u003cp\u003eThe survey was administered in September 2024 using Google Forms (Google LLC, United States) and distributed via Telegram (Telegram FZ LLC, British Virgin Islands), Viber (Rakuten Inc., Israel), and text messaging and electronic mail to the 121 members of AFNI and 96 resident members of PANSR [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The complete list of participants was obtained through the AFNI website and PANSR directory. Neurosurgery training in the Philippines consists of one year of general surgery followed by five years of neurosurgery; we did not include the trainees who were still in general surgery. Reminder messages were sent after the first and third week of initial distribution. Survey responses were anonymized.\u003c/p\u003e\u003cp\u003e The authors state that this research was conducted in accordance with the Helsinki Declaration as revised in 2013.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eThe data gathered was compared between consultants and residents, using pain scores as the main outcome variable. A Shapiro-Wilk test was performed to determine normality of the pain scores. Afterwards, a Mann-Whitney U test was used to compare scores between the two groups. Statistical significance was set at 0.05. The statistical software used was R (R Core Team, Vienna, Austria).\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cem\u003eDemographic,\u003c/em\u003e \u003cem\u003eClinical,\u003c/em\u003e \u003cem\u003eand\u003c/em\u003e \u003cem\u003eWork-related\u003c/em\u003e \u003cem\u003eData\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe had a total of 100 respondents (56 consultants and 44 residents), with a response rate of 46% (100/217). Consultants and residents had the following characteristics, respectively: mean ages of 48 (SD = 9.7) and 31.5 years (SD = 3.1), were mostly male (83.9% and 68.2%), mostly right-handed (85.8% and 84.1), and on average had a BMI of 27.7 (SD = 4) and 26.5 (SD = 4.5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAmong the consultants, the most common comorbid condition was hypertension (n=23) followed by diabetes mellitus (n=14). The most commonly reported musculoskeletal condition was degenerative lumbar disease (n=10), followed by cervical spondylosis (n=7). Eleven consultants had a history of musculoskeletal injury for which two of them underwent surgery. Majority exercised between 0.5-4 hours a week (55.4%, n = 31). Only 7.2% of consultants (n=4) reported the regular use of analgesics of at least once a month. In general, they had an average tenure of 14.6 years (SD = 9.8) and practiced neurosurgery in both private and public hospitals (60.7%, n = 34).\u003c/p\u003e\n\u003cp\u003eIn comparison, majority of the residents did not have a comorbid condition (n=40). The most common musculoskeletal condition reported in this group was gouty arthritis (n=3), and only five reported a history of musculoskeletal injury, none of which required surgery. Most did not exercise at all (43.2%, n = 19) or only exercised 0.5-4 hours a week (40.9%). Residents were also distributed evenly among the first to fifth years of their neurosurgical training and mostly practiced in the public setting (61.4%, n=27). Table 1 shows the summary of the demographic, clinical, and work-related data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIndex Operations\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTables 2 and 3 summarize the operative data for the five index operations. Consultants more commonly reported being the primary surgeons for their cases (SC 98.2%, IC 96.4%, TS 83.9%, VPS 100%, and SS 91.1%). Residents, on the other hand, more commonly reported being the assists for these cases (SC 52.3%, IC 63.6%, TS 79.5%, VPS 34.1%, and SS 75.0%). In all five index operations, both consultants and residents preferred to stand.\u003c/p\u003e\n\u003cp\u003eTable 1. Demographic, clinical, and work-related data among the respondents\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69.2308%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3265%;\"\u003e\n \u003cp\u003eConsultants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4427%;\"\u003e\n \u003cp\u003eResidents\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69.2308%;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3265%;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4427%;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69.2308%;\"\u003e\n \u003cp\u003eAge (years, Mean \u003cu\u003e+\u003c/u\u003e SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3265%;\"\u003e\n \u003cp\u003e48.0 \u003cu\u003e+\u003c/u\u003e 9.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4427%;\"\u003e\n \u003cp\u003e31.5 \u003cu\u003e+\u003c/u\u003e 3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69.2308%;\"\u003e\n \u003cp\u003eSex (Male, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3265%;\"\u003e\n \u003cp\u003e47 (83.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4427%;\"\u003e\n \u003cp\u003e30 (68.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69.2308%;\"\u003e\n \u003cp\u003eHeight (cm, Mean \u003cu\u003e+\u003c/u\u003e SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3265%;\"\u003e\n \u003cp\u003e168.5 \u003cu\u003e+\u003c/u\u003e 8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4427%;\"\u003e\n \u003cp\u003e164.9 \u003cu\u003e+\u003c/u\u003e 8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69.2308%;\"\u003e\n \u003cp\u003eWeight (kg, Mean \u003cu\u003e+\u003c/u\u003e SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3265%;\"\u003e\n \u003cp\u003e78.8 \u003cu\u003e+\u003c/u\u003e 13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4427%;\"\u003e\n \u003cp\u003e72.3 \u003cu\u003e+\u003c/u\u003e 14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69.2308%;\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e, Mean \u003cu\u003e+\u003c/u\u003e SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3265%;\"\u003e\n \u003cp\u003e27.7 \u003cu\u003e+\u003c/u\u003e 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4427%;\"\u003e\n \u003cp\u003e26.5 \u003cu\u003e+\u003c/u\u003e 4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69.2308%;\"\u003e\n \u003cp\u003e\u003cu\u003eHandedness\u0026nbsp;\u003c/u\u003e(n, %)\u003c/p\u003e\n \u003cp\u003eRight\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLeft\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAmbidextrous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3265%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e48 (85.8%)\u003c/p\u003e\n \u003cp\u003e4 (7.1%)\u003c/p\u003e\n \u003cp\u003e4 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4427%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e37 (84.1%)\u003c/p\u003e\n \u003cp\u003e6 (13.6%)\u003c/p\u003e\n \u003cp\u003e1 (2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69.2308%;\"\u003e\n \u003cp\u003e\u003cu\u003eComorbid conditions\u0026nbsp;\u003c/u\u003e(n, %)\u003c/p\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003cp\u003eDiabetes Mellitus\u003c/p\u003e\n \u003cp\u003eHeart disease\u003c/p\u003e\n \u003cp\u003eOthers (dyslipidemia, pulmonary disease, endocrine disease, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3265%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23 (41.1%)\u003c/p\u003e\n \u003cp\u003e14 (25.0%)\u003c/p\u003e\n \u003cp\u003e4 (7.2%)\u003c/p\u003e\n \u003cp\u003e6 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4427%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (6.8%)\u003c/p\u003e\n \u003cp\u003e1 (2.3%)\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003cp\u003e2 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69.2308%;\"\u003e\n \u003cp\u003e\u003cu\u003eMusculoskeletal conditions\u003c/u\u003e (n, %)\u003c/p\u003e\n \u003cp\u003eDegenerative lumbar disease\u003c/p\u003e\n \u003cp\u003eCervical Spondylosis\u003c/p\u003e\n \u003cp\u003eOsteoarthritis\u003c/p\u003e\n \u003cp\u003eGouty arthritis\u003c/p\u003e\n \u003cp\u003eOthers (scoliosis, carpal tunnel syndrome, de Quervain\u0026rsquo;s tenosynovitis, ligamentous injuries, thoracic spondylitis, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3265%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10 (17.9%)\u003c/p\u003e\n \u003cp\u003e7 (12.5%)\u003c/p\u003e\n \u003cp\u003e5 (8.9%)\u003c/p\u003e\n \u003cp\u003e2 (3.6%)\u003c/p\u003e\n \u003cp\u003e7 (12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4427%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003cp\u003e1 (2.3%)\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003cp\u003e3 (6.8%)\u003c/p\u003e\n \u003cp\u003e7 (15.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69.2308%;\"\u003e\n \u003cp\u003eHistory of musculoskeletal injury (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3265%;\"\u003e\n \u003cp\u003e11 (19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4427%;\"\u003e\n \u003cp\u003e5 (11.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69.2308%;\"\u003e\n \u003cp\u003eHistory of surgery for musculoskeletal injury (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3265%;\"\u003e\n \u003cp\u003e2 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4427%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69.2308%;\"\u003e\n \u003cp\u003e\u003cu\u003eAnalgesic use\u003c/u\u003e (n, %)\u003c/p\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003cp\u003eAs needed\u003c/p\u003e\n \u003cp\u003eRegular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3265%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e39 (69.6%)\u003c/p\u003e\n \u003cp\u003e13 (23.2%)\u003c/p\u003e\n \u003cp\u003e4 (7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4427%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e32 (72.7%)\u003c/p\u003e\n \u003cp\u003e7 (15.9%)\u003c/p\u003e\n \u003cp\u003e5 (11.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69.2308%;\"\u003e\n \u003cp\u003e\u003cu\u003eExercise activity\u003c/u\u003e (n, %)\u003c/p\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003cp\u003e0.5-4 hours a week\u003c/p\u003e\n \u003cp\u003e4-7 hours a week\u003c/p\u003e\n \u003cp\u003eMore than 7 hours a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3265%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10 (17.9%)\u003c/p\u003e\n \u003cp\u003e31 (55.4%)\u003c/p\u003e\n \u003cp\u003e12 (21.4%)\u003c/p\u003e\n \u003cp\u003e3 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4427%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19 (43.2%)\u003c/p\u003e\n \u003cp\u003e18 (40.9%)\u003c/p\u003e\n \u003cp\u003e5 (11.4%)\u003c/p\u003e\n \u003cp\u003e2 (4.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69.2308%;\"\u003e\n \u003cp\u003eYears in practice (Mean \u003cu\u003e+\u003c/u\u003e SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3265%;\"\u003e\n \u003cp\u003e14.6 \u003cu\u003e+\u003c/u\u003e 9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4427%;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69.2308%;\"\u003e\n \u003cp\u003e\u003cu\u003eArea of practice/training\u0026nbsp;\u003c/u\u003e(n, %)\u003c/p\u003e\n \u003cp\u003ePublic\u003c/p\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003cp\u003eBoth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3265%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (5.4%)\u003c/p\u003e\n \u003cp\u003e19 (33.9%)\u003c/p\u003e\n \u003cp\u003e34 (60.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4427%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27 (61.4%)\u003c/p\u003e\n \u003cp\u003e2 (4.6%)\u003c/p\u003e\n \u003cp\u003e15 (34.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69.2308%;\"\u003e\n \u003cp\u003e\u003cu\u003eYear level\u003c/u\u003e (n, %)\u003c/p\u003e\n \u003cp\u003eNS1\u003c/p\u003e\n \u003cp\u003eNS2\u003c/p\u003e\n \u003cp\u003eNS3\u003c/p\u003e\n \u003cp\u003eNS4\u003c/p\u003e\n \u003cp\u003eNS5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.3265%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.4427%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11 (25.0%)\u003c/p\u003e\n \u003cp\u003e12 (27.2%)\u003c/p\u003e\n \u003cp\u003e6 (13.6%)\u003c/p\u003e\n \u003cp\u003e7 (15.9%)\u003c/p\u003e\n \u003cp\u003e8 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eBoth SC and IC had similar findings. Consultants and residents both preferred using the microscope (SC 82.1% and 75.0%; IC 87.5% and 81.8%; consultants and residents respectively) for magnification, both groups used high speed drills more than other craniotomy equipment (SC 39.3% and 40.9%; IC 41.1% and 43.2%), and both reported an average operating time of 2-4 hours (SC 78.6% and 72.7%; IC 53.8% and 68.2%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor TS, consultants generally performed more microscopic surgeries (48.2%) while residents had more experience doing endoscopic transsphenoidal surgeries (43.1%) or both (45.5%). Consultants more frequently used the osteotome (55.3%) while residents preferred the high speed drill (77.3%). Both consultants and residents also reported an average operating time of 2-4 hours (78.6% and 77.2%, respectively).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsultants and residents had similar responses for VPS insertions. Both groups preferred to use a Hudson brace as the burr hole tool (69.6% and 77.3%), pass the shunt caudal to cranial (66.1% and 63.6%), and open the abdomen with no assistance from general surgery (96.4% and 100%). They both reported an estimated operating time of less than 2 hours (83.9% and 77.3%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor SS, both consultants and residents most frequently used the C-arm for intraoperative navigation (58.9% and 56.8%) and preferred using the microscope (62.5% and 65.9%) for magnification. Most also used bone rongeurs (76.8% and 65.9%) rather than high speed drills (23.2% and 34.1%). Majority of respondents did not commonly perform fusion procedures (69.0%) and also did not wear lead gowns during surgery (76.0%). The average estimated operating time for spine procedures by all respondents was 2-4 hours (68.0%).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePain Scores\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll respondents reported pain in at least one anatomic region for all five index procedures. For consultants, the greatest prevalence of pain was at the neck (SC 76.8%, IC 89.3%, TS 69.6%, VPS 33.9%, and SS 71.4%). For residents, it was at the lower back (SC 84.1%, IC 86.4%, TS 75.0%, VPS 47.7%, and SS 79.5%). Per procedure, the greatest prevalence of pain was the neck for SC (83%) and IC (92%) and the lower back for TS (72.0%), VPS (45.0%), and SS (76.0%). (Table 4)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA Shapiro-Wilk test showed that both consultant and resident pain scores for all five index operations were not normally distributed. A Mann-Whitney U test was used to compare the mean pain scores per anatomic region and per procedure between consultants and residents. The mean pain scores were greater in residents than consultants across all anatomic regions and index operations (Table 4). Figure 1 uses a heat map to illustrate the distribution of the pain and their relative severity.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. Operative data of consultants and residents in SC and IC\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupratentorial Craniotomy (SC)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfratentorial Craniotomy (IC)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003eConsultants (n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eResidents (n=44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eConsultants (n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eResidents (n=44)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cu\u003ePredominant role\u003c/u\u003e (n, %)\u003c/p\u003e\n \u003cp\u003ePrimary surgeon\u003c/p\u003e\n \u003cp\u003eAssist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e55 (98.2%)\u003c/p\u003e\n \u003cp\u003e1 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21 (47.7%)\u003c/p\u003e\n \u003cp\u003e23 (52.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e54 (96.4%)\u003c/p\u003e\n \u003cp\u003e2 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16 (36.4%)\u003c/p\u003e\n \u003cp\u003e28 (63.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cu\u003ePredominant position\u003c/u\u003e (n, %)\u003c/p\u003e\n \u003cp\u003eSitting\u003c/p\u003e\n \u003cp\u003eStanding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27 (48.2%)\u003c/p\u003e\n \u003cp\u003e29 (51.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11 (25.0%)\u003c/p\u003e\n \u003cp\u003e33 (75.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19 (33.9%)\u003c/p\u003e\n \u003cp\u003e37 (66.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10 (22.7%)\u003c/p\u003e\n \u003cp\u003e34 (77.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cu\u003eMagnification\u0026nbsp;\u003c/u\u003e(n, %)\u003c/p\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003cp\u003eCorrective lenses\u003c/p\u003e\n \u003cp\u003eLoupes\u003c/p\u003e\n \u003cp\u003eMicroscope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7 (12.5%)\u003c/p\u003e\n \u003cp\u003e33 (58.9%)\u003c/p\u003e\n \u003cp\u003e38 (67.9%)\u003c/p\u003e\n \u003cp\u003e46 (82.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11 (25.0%)\u003c/p\u003e\n \u003cp\u003e23 (52.3%)\u003c/p\u003e\n \u003cp\u003e22 (50.0%)\u003c/p\u003e\n \u003cp\u003e33 (75.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (7.14%)\u003c/p\u003e\n \u003cp\u003e33 (58.9%)\u003c/p\u003e\n \u003cp\u003e35 (62.5%)\u003c/p\u003e\n \u003cp\u003e49 (87.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7 (15.9%)\u003c/p\u003e\n \u003cp\u003e19 (43.2%)\u003c/p\u003e\n \u003cp\u003e18 (40.9%)\u003c/p\u003e\n \u003cp\u003e36 (81.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cu\u003eCraniotomy tool\u0026nbsp;\u003c/u\u003e(n, %)\u003c/p\u003e\n \u003cp\u003eHudson brace \u0026amp; Gigli wire\u003c/p\u003e\n \u003cp\u003eCraniotome\u003c/p\u003e\n \u003cp\u003eHigh speed drill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12 (21.4%)\u003c/p\u003e\n \u003cp\u003e22 (39.3%)\u003c/p\u003e\n \u003cp\u003e22 (39.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12 (27.3%)\u003c/p\u003e\n \u003cp\u003e14 (31.8%)\u003c/p\u003e\n \u003cp\u003e18 (40.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12 (21.4%)\u003c/p\u003e\n \u003cp\u003e21 (37.5%)\u003c/p\u003e\n \u003cp\u003e23 (41.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11 (25.0%)\u003c/p\u003e\n \u003cp\u003e14 (31.8%)\u003c/p\u003e\n \u003cp\u003e19 (43.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cu\u003eEstimated length of case\u0026nbsp;\u003c/u\u003e(n, %)\u003c/p\u003e\n \u003cp\u003eLess than 2 hours\u003c/p\u003e\n \u003cp\u003e2-4 hours\u003c/p\u003e\n \u003cp\u003e\u0026gt;4 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (3.6%)\u003c/p\u003e\n \u003cp\u003e44 (78.6%)\u003c/p\u003e\n \u003cp\u003e10 (17.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (2.3%)\u003c/p\u003e\n \u003cp\u003e32 (72.7%)\u003c/p\u003e\n \u003cp\u003e11 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (1.8%)\u003c/p\u003e\n \u003cp\u003e30 (53.8%)\u003c/p\u003e\n \u003cp\u003e25 (44.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003cp\u003e30 (68.2%)\u003c/p\u003e\n \u003cp\u003e14 (31.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3. Operative data of consultants and residents in TS, VPS, and SS\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 500px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTranssphenoidal Surgery (TS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eConsultants (n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eResidents (n=44)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003ePredominant role (n, %)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003ePrimary surgeon\u003c/p\u003e\n \u003cp\u003eAssist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e47 (83.9%)\u003c/p\u003e\n \u003cp\u003e9 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (20.4%)\u003c/p\u003e\n \u003cp\u003e35 (79.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003ePredominant position (n, %)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003eSitting\u003c/p\u003e\n \u003cp\u003eStanding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (16.1%)\u003c/p\u003e\n \u003cp\u003e47 (83.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (2.3%)\u003c/p\u003e\n \u003cp\u003e43 (97.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eType of transsphenoidal surgery\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003eMicroscopic\u003c/p\u003e\n \u003cp\u003eEndoscopic\u003c/p\u003e\n \u003cp\u003eBoth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27 (48.2%)\u003c/p\u003e\n \u003cp\u003e11 (19.6%)\u003c/p\u003e\n \u003cp\u003e18 (32.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (11.3%)\u003c/p\u003e\n \u003cp\u003e19 (43.1%)\u003c/p\u003e\n \u003cp\u003e20 (45.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eSellotomy tool (n, %)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003eOsteotome\u003c/p\u003e\n \u003cp\u003eHigh speed drill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e31 (55.3%)\u003c/p\u003e\n \u003cp\u003e25 (44.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10 (22.7%)\u003c/p\u003e\n \u003cp\u003e34 (77.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eEstimated length of case (n, %)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003eLess than 2 hours\u003c/p\u003e\n \u003cp\u003e2-4 hours\u003c/p\u003e\n \u003cp\u003e\u0026gt;4 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (5.4%)\u003c/p\u003e\n \u003cp\u003e44 (78.6%)\u003c/p\u003e\n \u003cp\u003e9 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7 (15.9%)\u003c/p\u003e\n \u003cp\u003e34 (77.2%)\u003c/p\u003e\n \u003cp\u003e3 (6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 500px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVentriculoperitoneal Shunt (VPS) Insertion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003ePredominant role\u003c/u\u003e (n, %)\u003c/p\u003e\n \u003cp\u003ePrimary surgeon\u003c/p\u003e\n \u003cp\u003eAssist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e56 (100%)\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e29 (65.9%)\u003c/p\u003e\n \u003cp\u003e15 (34.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003ePredominant position\u003c/u\u003e (n, %)\u003c/p\u003e\n \u003cp\u003eSitting\u003c/p\u003e\n \u003cp\u003eStanding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (10.7%)\u003c/p\u003e\n \u003cp\u003e50 (89.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (9.1%)\u003c/p\u003e\n \u003cp\u003e40 (90.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eMagnification\u0026nbsp;\u003c/u\u003e(n, %)\u003c/p\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003cp\u003eCorrective lenses\u003c/p\u003e\n \u003cp\u003eLoupes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18 (32.1%)\u003c/p\u003e\n \u003cp\u003e33 (58.9%)\u003c/p\u003e\n \u003cp\u003e9 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22 (50.0%)\u003c/p\u003e\n \u003cp\u003e21 (47.7%)\u003c/p\u003e\n \u003cp\u003e2 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eBurr hole tool\u0026nbsp;\u003c/u\u003e(n, %)\u003c/p\u003e\n \u003cp\u003eHudson brace\u003c/p\u003e\n \u003cp\u003eCraniotome\u003c/p\u003e\n \u003cp\u003eHigh speed drill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e39 (69.6%)\u003c/p\u003e\n \u003cp\u003e10 (17.9%)\u003c/p\u003e\n \u003cp\u003e7 (12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e34 (77.3%)\u003c/p\u003e\n \u003cp\u003e8 (18.2%)\u003c/p\u003e\n \u003cp\u003e2 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eShunt passing\u003c/u\u003e (n, %)\u003c/p\u003e\n \u003cp\u003eCranial to caudal\u003c/p\u003e\n \u003cp\u003eCaudal to cranial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19 (33.9%)\u003c/p\u003e\n \u003cp\u003e37 (66.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16 (36.4%)\u003c/p\u003e\n \u003cp\u003e28 (63.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eAbdominal opening\u003c/u\u003e (n, %)\u003c/p\u003e\n \u003cp\u003eBy Neurosurgery\u003c/p\u003e\n \u003cp\u003eBy General surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e54 (96.4%)\u003c/p\u003e\n \u003cp\u003e2 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e44 (100%)\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eEstimated length of case\u0026nbsp;\u003c/u\u003e(n, %)\u003c/p\u003e\n \u003cp\u003eLess than 2 hours\u003c/p\u003e\n \u003cp\u003e2-4 hours\u003c/p\u003e\n \u003cp\u003e\u0026gt;4 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e47 (83.9%)\u003c/p\u003e\n \u003cp\u003e9 (16.1%)\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e34 (77.3%)\u003c/p\u003e\n \u003cp\u003e10 (22.7%)\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 500px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpine surgery (SS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003ePredominant role (n, %)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003ePrimary surgeon\u003c/p\u003e\n \u003cp\u003eAssist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e51 (91.1%)\u003c/p\u003e\n \u003cp\u003e5 (8.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11 (25.0%)\u003c/p\u003e\n \u003cp\u003e33 (75.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003ePredominant position (n, %)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003eSitting\u003c/p\u003e\n \u003cp\u003eStanding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e56 (100%)\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e41 (93.2%)\u003c/p\u003e\n \u003cp\u003e3 (6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eIntraoperative navigation\u0026nbsp;(n, %)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003eX-ray\u003c/p\u003e\n \u003cp\u003eC-arm\u003c/p\u003e\n \u003cp\u003eStereotaxy/image guidance\u003c/p\u003e\n \u003cp\u003eO-arm\u003c/p\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18 (32.1%)\u003c/p\u003e\n \u003cp\u003e33 (58.9%)\u003c/p\u003e\n \u003cp\u003e1 (1.8%)\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003cp\u003e4 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17 (38.6)\u003c/p\u003e\n \u003cp\u003e25 (56.8)\u003c/p\u003e\n \u003cp\u003e1 (2.3%)\u003c/p\u003e\n \u003cp\u003e1 (2.3%)\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eMagnification (n, %)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003cp\u003eCorrective lenses\u003c/p\u003e\n \u003cp\u003eLoupes\u003c/p\u003e\n \u003cp\u003eMicroscope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (5.4%)\u003c/p\u003e\n \u003cp\u003e30 (53.6%)\u003c/p\u003e\n \u003cp\u003e33 (58.9%)\u003c/p\u003e\n \u003cp\u003e35 (62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10 (22.7%)\u003c/p\u003e\n \u003cp\u003e18 (40.9%)\u003c/p\u003e\n \u003cp\u003e15 (34.1%)\u003c/p\u003e\n \u003cp\u003e29 (65.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eCraniotomy tool (n, %)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003eBone rongeur\u003c/p\u003e\n \u003cp\u003eHigh speed drill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e43 (76.8%)\u003c/p\u003e\n \u003cp\u003e13 (23.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e29 (65.9%)\u003c/p\u003e\n \u003cp\u003e15 (34.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eCommonly perform fusion (n, %)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15 (26.8%)\u003c/p\u003e\n \u003cp\u003e41 (73.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16 (36.4%)\u003c/p\u003e\n \u003cp\u003e28 (63.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eUsed lead gown intraop (n, %)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (16.1%)\u003c/p\u003e\n \u003cp\u003e47 (83.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15 (34.1%)\u003c/p\u003e\n \u003cp\u003e29 (65.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eEstimated length of case (n, %)\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003eLess than 2 hours\u003c/p\u003e\n \u003cp\u003e2-4 hours\u003c/p\u003e\n \u003cp\u003e\u0026gt;4 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (5.4%)\u003c/p\u003e\n \u003cp\u003e36 (64.2%)\u003c/p\u003e\n \u003cp\u003e17 (30.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (9.1%)\u003c/p\u003e\n \u003cp\u003e32 (72.7%)\u003c/p\u003e\n \u003cp\u003e8 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 4. Statistical analysis between pain scores of consultants and residents for SC, IC, TS, VPS, and SS\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupratentorial Craniotomy (SC)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 192px;\"\u003e\n \u003cp\u003ePrevalence of pain (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 340px;\"\u003e\n \u003cp\u003ePain scores\u003cu\u003e\u0026nbsp;\u003c/u\u003e (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003eConsultants\u003c/p\u003e\n \u003cp\u003e(n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eResidents\u003c/p\u003e\n \u003cp\u003e(n=44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eConsultants\u003c/p\u003e\n \u003cp\u003e(n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eResidents\u003c/p\u003e\n \u003cp\u003e(n=44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003cp\u003e(Mann-Whitney U)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eHead\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e15 (26.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e35 (79.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.6 \u003cu\u003e+\u003c/u\u003e 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2.7 \u003cu\u003e+\u003c/u\u003e 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=3.14x10\u003csup\u003e-7\u003c/sup\u003e (U=693.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eEyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e17 (30.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e29 (65.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.5 \u003cu\u003e+\u003c/u\u003e 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2.1 \u003cu\u003e+\u003c/u\u003e 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=7.61x10\u003csup\u003e-5\u003c/sup\u003e (U=796.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eTeeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e4 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e5 (11.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.1 \u003cu\u003e+\u003c/u\u003e 0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.3 \u003cu\u003e+\u003c/u\u003e 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.148 (U=1056.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eNeck\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e43 (76.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e40 (90.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.3 \u003cu\u003e+\u003c/u\u003e 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e4.0 \u003cu\u003e+\u003c/u\u003e 2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0022 (U=810)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eShoulder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e46 (82.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e34 (77.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.5 \u003cu\u003e+\u003c/u\u003e 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e3.5 \u003cu\u003e+\u003c/u\u003e 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0276 (U=933.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eUpper back\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e41 (73.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e38 (86.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.1 \u003cu\u003e+\u003c/u\u003e 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e3.4 \u003cu\u003e+\u003c/u\u003e 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0053 (U=850.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eElbows\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e15 (26.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e18 (40.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.6 \u003cu\u003e+\u003c/u\u003e 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.5 \u003cu\u003e+\u003c/u\u003e 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.0504 (U=1012.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eWrist/hand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e29 (51.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e32 (72.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.3 \u003cu\u003e+\u003c/u\u003e 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2.4 \u003cu\u003e+\u003c/u\u003e 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0078 (U=877.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eLower back\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e42 (75.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e37 (84.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.4 \u003cu\u003e+\u003c/u\u003e 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e3.2 \u003cu\u003e+\u003c/u\u003e 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0343 (U=946.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eHips/Thigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e16 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e20 (45.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.8 \u003cu\u003e+\u003c/u\u003e 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.7 \u003cu\u003e+\u003c/u\u003e 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.0569 (U=1012.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eKnees\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e19 (33.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e25 (56.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.9 \u003cu\u003e+\u003c/u\u003e 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.9 \u003cu\u003e+\u003c/u\u003e 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0132 (U=925.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eAnkles/Feet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e21 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e30 (68.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.1 \u003cu\u003e+\u003c/u\u003e 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2.6 \u003cu\u003e+\u003c/u\u003e 2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0038 (U=856.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eTOTAL Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.3 \u003cu\u003e+\u003c/u\u003e 1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e2.4 \u003cu\u003e+\u003c/u\u003e 2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.107 (U=54,851.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfratentorial Craniotomy (IC)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 192px;\"\u003e\n \u003cp\u003ePrevalence of pain (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 340px;\"\u003e\n \u003cp\u003ePain scores\u003cu\u003e\u0026nbsp;\u003c/u\u003e (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003eConsultants\u003c/p\u003e\n \u003cp\u003e(n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eResidents\u003c/p\u003e\n \u003cp\u003e(n=44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eConsultants\u003c/p\u003e\n \u003cp\u003e(n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eResidents\u003c/p\u003e\n \u003cp\u003e(n=44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003cp\u003e(Mann-Whitney U)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eHead\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e20 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e35 (79.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.8 \u003cu\u003e+\u003c/u\u003e 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e2.7 \u003cu\u003e+\u003c/u\u003e 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.00021 (U=892.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eEyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e17 (30.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e29 (65.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.5 \u003cu\u003e+\u003c/u\u003e 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e2.2 \u003cu\u003e+\u003c/u\u003e 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.00114 (U=981.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eTeeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e5 (8.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e8 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.2 \u003cu\u003e+\u003c/u\u003e 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.5 \u003cu\u003e+\u003c/u\u003e 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.2421 (U=1448.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eNeck\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e50 (89.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e42 (95.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e2.7 \u003cu\u003e+\u003c/u\u003e 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e4.2 \u003cu\u003e+\u003c/u\u003e 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.00324 (U=833.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eShoulder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e50 (89.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e38 (86.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e2.6 \u003cu\u003e+\u003c/u\u003e 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e3.5 \u003cu\u003e+\u003c/u\u003e 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.1144 (U=1031.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eUpper back\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e43 (76.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e39 (88.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e2.2 \u003cu\u003e+\u003c/u\u003e 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e3.7 \u003cu\u003e+\u003c/u\u003e 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0336 (U=1092.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eElbows\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e17 (30.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e20 (45.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.7 \u003cu\u003e+\u003c/u\u003e 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.4 \u003cu\u003e+\u003c/u\u003e 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.0890 (U=1265.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eWrist/hand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e26 (46.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e29 (65.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.3 \u003cu\u003e+\u003c/u\u003e 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e2.3 \u003cu\u003e+\u003c/u\u003e 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0150 (U=1078.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eLower back\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e40 (71.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e38 (86.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e2.3 \u003cu\u003e+\u003c/u\u003e 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e3.0 \u003cu\u003e+\u003c/u\u003e 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.1088 (U=1174.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eHips/Thigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e19 (33.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e21 (47.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.8 \u003cu\u003e+\u003c/u\u003e 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.6 \u003cu\u003e+\u003c/u\u003e 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.0901 (U=1261.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eKnees\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e23 (41.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e23 (52.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.0 \u003cu\u003e+\u003c/u\u003e 1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.8 \u003cu\u003e+\u003c/u\u003e 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0289 (U=889.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eAnkles/Feet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e23 (41.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e28 (63.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.1 \u003cu\u003e+\u003c/u\u003e 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e2.0 \u003cu\u003e+\u003c/u\u003e 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0088 (U=862.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eTOTAL Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.4 \u003cu\u003e+\u003c/u\u003e 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e2.4 \u003cu\u003e+\u003c/u\u003e 2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=1.28x10\u003csup\u003e-8\u003c/sup\u003e (U=26284.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTranssphenoidal Surgery (TS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 192px;\"\u003e\n \u003cp\u003ePrevalence of pain (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 340px;\"\u003e\n \u003cp\u003ePain scores\u003cu\u003e\u0026nbsp;\u003c/u\u003e (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003eConsultants\u003c/p\u003e\n \u003cp\u003e(n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eResidents\u003c/p\u003e\n \u003cp\u003e(n=44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eConsultants\u003c/p\u003e\n \u003cp\u003e(n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eResidents\u003c/p\u003e\n \u003cp\u003e(n=44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003cp\u003e(Mann-Whitney U)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eHead\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e17 (30.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e25 (56.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.7 \u003cu\u003e+\u003c/u\u003e 1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.8 \u003cu\u003e+\u003c/u\u003e 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.00094 (U771.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eEyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e18 (32.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e22 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.6 \u003cu\u003e+\u003c/u\u003e 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.6 \u003cu\u003e+\u003c/u\u003e 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.03024 (U1061.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eTeeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e5 (8.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e5 (11.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.1 \u003cu\u003e+\u003c/u\u003e 0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.4 \u003cu\u003e+\u003c/u\u003e 1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.0762 (U1006.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eNeck\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e39 (69.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e26 (59.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.9 \u003cu\u003e+\u003c/u\u003e 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e2.4 \u003cu\u003e+\u003c/u\u003e 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.687 (U1175.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eShoulder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e37 (66.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e27 (61.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.9 \u003cu\u003e+\u003c/u\u003e 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e2.5 \u003cu\u003e+\u003c/u\u003e 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.368 (U1065.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eUpper back\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e36 (64.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e30 (68.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e2.0 \u003cu\u003e+\u003c/u\u003e 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e2.5 \u003cu\u003e+\u003c/u\u003e 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.176 (U1003.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eElbows\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e19 (33.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e18 (40.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.8 \u003cu\u003e+\u003c/u\u003e 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.5 \u003cu\u003e+\u003c/u\u003e 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.219 (U963.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eWrist/hand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e22 (39.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e23 (52.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.1 \u003cu\u003e+\u003c/u\u003e 1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.7 \u003cu\u003e+\u003c/u\u003e 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.134 (U984.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eLower back\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e39 (69.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e33 (75.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e2.4 \u003cu\u003e+\u003c/u\u003e 2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e2.5 \u003cu\u003e+\u003c/u\u003e 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.737 (U1184.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eHips/Thigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e23 (41.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e18 (40.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.3 \u003cu\u003e+\u003c/u\u003e 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.2 \u003cu\u003e+\u003c/u\u003e 1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.886 (U1143.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eKnees\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e23 (41.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e20 (45.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.2 \u003cu\u003e+\u003c/u\u003e 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.3 \u003cu\u003e+\u003c/u\u003e 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.735 (U1254.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eAnkles/Feet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e21 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e26 (59.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.1 \u003cu\u003e+\u003c/u\u003e 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.7 \u003cu\u003e+\u003c/u\u003e 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.020 (U980.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eTOTAL Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.3 \u003cu\u003e+\u003c/u\u003e 1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.8 \u003cu\u003e+\u003c/u\u003e 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=2.17x10\u003csup\u003e-5\u003c/sup\u003e (U18537.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVentriculoperitoneal Shunt Insertion (VPS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 192px;\"\u003e\n \u003cp\u003ePrevalence of pain (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 340px;\"\u003e\n \u003cp\u003ePain scores\u003cu\u003e\u0026nbsp;\u003c/u\u003e (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003eConsultants\u003c/p\u003e\n \u003cp\u003e(n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eResidents\u003c/p\u003e\n \u003cp\u003e(n=44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eConsultants\u003c/p\u003e\n \u003cp\u003e(n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eResidents\u003c/p\u003e\n \u003cp\u003e(n=44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003cp\u003e(Mann-Whitney U)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eHead\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e8 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e18 (40.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.2 \u003cu\u003e+\u003c/u\u003e 0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.8 \u003cu\u003e+\u003c/u\u003e 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0041 (U900.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eEyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e8 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e14 (31.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.2 \u003cu\u003e+\u003c/u\u003e 0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.7 \u003cu\u003e+\u003c/u\u003e 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0287 (U1009.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eTeeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e2 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e5 (11.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.04 \u003cu\u003e+\u003c/u\u003e 0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.3 \u003cu\u003e+\u003c/u\u003e 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0387 (U1022.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eNeck\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e19 (33.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e17 (38.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.6 \u003cu\u003e+\u003c/u\u003e 1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.4 \u003cu\u003e+\u003c/u\u003e 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.425 (U821.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eShoulder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e21 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e21 (47.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.7 \u003cu\u003e+\u003c/u\u003e 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.6 \u003cu\u003e+\u003c/u\u003e 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.120 (U1013.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eUpper back\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e19 (33.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e24 (54.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.6 \u003cu\u003e+\u003c/u\u003e 1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.6\u003cu\u003e+\u003c/u\u003e 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.015 (U965.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eElbows\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e15 (26.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e18 (40.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.4 \u003cu\u003e+\u003c/u\u003e 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.0 \u003cu\u003e+\u003c/u\u003e 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.104 (U1166.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eWrist/hand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e15 (26.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e23 (52.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.5 \u0026shy;\u003cu\u003e+\u003c/u\u003e 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.6 \u003cu\u003e+\u003c/u\u003e 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0035 (U875.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eLower back\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e24 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e21 (47.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.9 \u003cu\u003e+\u003c/u\u003e 1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.4 \u003cu\u003e+\u003c/u\u003e 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.349 (U1108.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eHips/Thigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e11 (19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e14 (31.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.4 \u003cu\u003e+\u003c/u\u003e 1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.6 \u003cu\u003e+\u003c/u\u003e 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.176 (U1004.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eKnees\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e12 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e14 (31.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.4 \u003cu\u003e+\u003c/u\u003e 0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.9 \u003cu\u003e+\u003c/u\u003e 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.158 (U998.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eAnkles/Feet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e12 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e18 (40.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.4 \u003cu\u003e+\u003c/u\u003e 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.2 \u003cu\u003e+\u003c/u\u003e 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0216 (U938.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eTOTAL Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.4 \u003cu\u003e+\u003c/u\u003e 1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.1 \u003cu\u003e+\u003c/u\u003e 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.168 (U34157.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpine Surgery (SS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 192px;\"\u003e\n \u003cp\u003ePrevalence of pain (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 340px;\"\u003e\n \u003cp\u003ePain scores\u003cu\u003e\u0026nbsp;\u003c/u\u003e (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003eConsultants\u003c/p\u003e\n \u003cp\u003e(n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eResidents\u003c/p\u003e\n \u003cp\u003e(n=44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eConsultants\u003c/p\u003e\n \u003cp\u003e(n=56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eResidents\u003c/p\u003e\n \u003cp\u003e(n=44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003cp\u003e(Mann-Whitney U)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eHead\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e16 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e28 (63.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.6 \u003cu\u003e+\u003c/u\u003e 1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.9 \u003cu\u003e+\u003c/u\u003e 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=5.0x10\u003csup\u003e-5\u003c/sup\u003e (U697.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eEyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e15 (26.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e19 (43.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.4 \u003cu\u003e+\u003c/u\u003e 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.3 \u003cu\u003e+\u003c/u\u003e 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0044 (U882.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eTeeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e4 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e5 (11.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.1 \u003cu\u003e+\u003c/u\u003e 0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.3 \u003cu\u003e+\u003c/u\u003e 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0118 (U1114.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eNeck\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e40 (71.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e35 (79.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e2.1 \u003cu\u003e+\u003c/u\u003e 1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e3.3 \u003cu\u003e+\u003c/u\u003e 2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0046 (U863.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eShoulder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e36 (64.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e32 (72.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.8 \u003cu\u003e+\u003c/u\u003e 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e3.1 \u003cu\u003e+\u003c/u\u003e 2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0030 (U827.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eUpper back\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e40 (71.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e30 (68.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.9 \u003cu\u003e+\u003c/u\u003e 1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e3.2 \u003cu\u003e+\u003c/u\u003e 2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0049 (U759.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eElbows\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e18 (32.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e20 (45.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.8\u003cu\u003e\u0026nbsp;+\u003c/u\u003e 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.6 \u003cu\u003e+\u003c/u\u003e 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0189 (U974.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eWrist/hand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e30 (53.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e29 (65.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.4 \u003cu\u003e+\u003c/u\u003e 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e2.8 \u003cu\u003e+\u003c/u\u003e 2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0032 (U915.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eLower back\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e41 (73.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e35 (79.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e2.4 \u003cu\u003e+\u003c/u\u003e 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e3.0 \u003cu\u003e+\u003c/u\u003e 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.094 (U873.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eHips/Thigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e27 (48.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e23 (52.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.2 \u003cu\u003e+\u003c/u\u003e 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.8 \u003cu\u003e+\u0026nbsp;\u003c/u\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.121 (U1221.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eKnees\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e23 (41.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e21 (47.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.0 \u003cu\u003e+\u003c/u\u003e 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e1.7 \u003cu\u003e+\u003c/u\u003e 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003ep=0.091 (U1210.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eAnkles/Feet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e21 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e28 (63.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.0 \u003cu\u003e+\u003c/u\u003e 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e2.2 \u003cu\u003e+\u003c/u\u003e 2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.0017 (U775.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eTOTAL Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1.2 \u003cu\u003e+\u003c/u\u003e 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e2.2 \u003cu\u003e+\u003c/u\u003e 2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep=7.83x10\u003csup\u003e-5\u003c/sup\u003e (U22662.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSC, IC, and SS were associated with the highest pain scores for both consultants and residents, especially at the neck (SC 2.3 \u0026plusmn; 2.2 vs 4.0 \u0026plusmn; 2.7, IC 2.7 \u0026plusmn; 2.2 vs 4.2 \u0026plusmn; 2.6, SS 2.1 \u0026plusmn; 1.9 vs 3.3 \u0026plusmn; 2.7), shoulder (SC 2.5 \u0026plusmn; 2.1 vs 3.5 \u0026plusmn; 2.6, IC 2.6 \u0026plusmn; 2.3 vs 3.5 \u0026plusmn; 2.6, SS 1.8 \u0026plusmn; 2.0 vs 3.1 \u0026plusmn; 2.8), upper back (SC 2.1 \u0026plusmn; 2.1 vs 3.4 \u0026plusmn; 2.4, IC 2.2 \u0026plusmn; 2.3 vs 3.7 \u0026plusmn; 2.6, SS 1.9 \u0026plusmn; 1.9 vs 3.2 \u0026plusmn; 2.8), wrists (SC 1.3 \u0026plusmn; 1.8, IC 1.3 \u0026plusmn; 2.0 vs 2.3 \u0026plusmn; 2.4, SS 1.4 \u0026plusmn; 1.8 vs 2.8 \u0026plusmn; 2.8), and lower back (SC 2.4 \u0026plusmn; 2.4 vs 3.2 \u0026plusmn; 2.3, IC 2.3 \u0026plusmn; 2.3 vs 3.0 \u0026plusmn; 2.3, SS 2.4 \u0026plusmn; 2.2 vs 3.0 \u0026plusmn; 2.6). Total mean pain scores were significantly different between IC (1.4 \u0026plusmn; 2.0 vs 2.4 \u0026plusmn; 2.5, p\u0026lt;0.0001), TS (1.3 \u0026plusmn; 1.9 vs 1.8 \u0026plusmn; 2.3, p\u0026lt;0.0002), and SS (1.2 \u0026plusmn; 1.8 vs 2.2 \u0026plusmn; 2.5, p\u0026lt;0.0007). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSubgroup analysis of resident pain scores between surgical roles (assist vs primary surgeon) showed higher mean pain scores as the assist for SC (2.7 vs 2.1, p=0.004), IC (2.6 vs 2.1, p=0.004), VPS (1.3 vs 0.9, p=0.003), and SS (2.2 vs 2.1, p=0.004). All four were statistically significant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cbr\u003e\u0026nbsp;Top 3 Procedures that Caused the Most Work-Related Pain\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFor consultants, the top three\u003cem\u003e\u0026nbsp;\u003c/em\u003eprocedures that caused the most work-related pain were lengthy and/or complex brain tumor surgery (n=61), especially infratentorial, skull base, and cerebellopontine angle tumors (Table 5). This was followed by spine cases (n=39), mainly laminectomy with or without fusion procedures, and transsphenoidal tumor excision (n=21). On the other hand, the residents\u0026rsquo; top three most painful procedures were spine surgery (n=29), infratentorial (n=28), and supratentorial (n=15) craniotomy.\u003c/p\u003e\n\u003cp\u003eTable 5. Procedures that cause the most work-related pain (consultants and residents)\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 311px;\"\u003e\n \u003cp\u003eCONSULTANTS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 326px;\"\u003e\n \u003cp\u003eRESIDENTS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eProcedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNumber of responses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eProcedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003eNumber of responses\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eBrain tumor surgery\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Infratentorial\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Skull base\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Cerebellopontine angle\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Others (lengthy, complex, pineal)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e27\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e10\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e8\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e16\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eSpine surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eSpine surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eInfratentorial craniotomy, not specified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eTranssphenoidal tumor excision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eSupratentorial craniotomy, not specified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eVascular neurosurgery (aneurysm clipping, bypass, AVM)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eTumor excision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eSupratentorial craniotomy, not specified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eTranssphenoidal tumor excision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eVPS insertion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eVascular neurosurgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eDecompressive\u0026nbsp;hemicraniectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eOthers (VPS insertion, skull base surgery, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e* AVM - arteriovenous malformation, VPS - ventriculoperitoneal shunt\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIntraoperative\u0026nbsp;and Behavioral Responses to Pain\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo alleviate the pain, consultants and residents responded similarly (Figures 2 and 3). The most common intraoperative responses were to stretch (n=86), change the height of the surgical field (n=61), change the angulation of the microscope (n=58), and sit down (n=57). Fifty-five respondents used specialized equipment (arm rests, compression stockings, ergonomic equipment), 45 distracted themselves by playing music or chatting with people, 42 took a break, and 35 ignored the pain.\u003c/p\u003e\n\u003cp\u003eThe most common behavioral response to work-related musculoskeletal pain was negative (n=51), namely, increased irritability, decreased patience, and decreased willingness to teach others. Others exercised more (n=42), while some adjusted their operative schedule to allow rest (n=33). Only 31 respondents sought medical consult and 15 underwent physical therapy, acupuncture, yoga, and other alternative forms of treatment. Twelve respondents spent time away from neurosurgery, with three considering early retirement. \u0026nbsp;\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe results of our survey showed the presence of work-related musculoskeletal pain for both consultants and residents across the five index operations. The anatomic regions that were most affected were the neck, shoulders, upper back, wrists, and lower back, which were also consistent with the existing literature [\u003cspan additionalcitationids=\"CR3 CR4 CR5\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Among the index operations, SC, IC, and SS had the highest pain scores, particularly among residents. Consultants had lower pain scores across all anatomic regions and index operations compared to residents.\u003c/p\u003e\u003cp\u003eIt has been reported that the prevalence of neck pain in the general population was 20%; shoulder pain, 24.7%-49%; wrist pain, 6%; and lower back pain, 7.8% [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Our findings showed a higher prevalence of pain in these anatomic areas among neurosurgeons, likely due to the physically demanding nature of the work. Our cohort had a high prevalence of upper back pain, an area which was not commonly reported in population studies of pain, except for a Finnish study that reported a 17% prevalence [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCraniotomies, both supra- and infratentorial, were associated with the highest pain scores in our cohort. This may be reflective of the neurosurgical practice in the Philippines, where the majority of procedures performed were cranial operations [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Thus, respondents may have reported more pain with craniotomy because this was the procedure they perform the most. Neurosurgeons have to adjust to the different positions required for these procedures, but inexperienced residents may not have learned to adapt, resulting in uncomfortable operating positions and increased pain. Lack of familiarity with microscope use, longer standing times, and poor operating posture could also have contributed to the increased pain scores of residents [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSpine procedures were responsible for much of the work-related musculoskeletal pain in our study and in published literature. Worldwide, spine surgeons have reported an increase in the prevalence of cervical and lumbar radiculopathy and rotator cuff disease, for which 4.6\u0026ndash;7.1% of surgeons with these conditions underwent surgery [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Majority of our respondents used bone rongeurs, and it has been found that repetitive use of hand instruments such as rongeurs during laminectomies can lead to wrist pain [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The use of lead gowns and performing fusion procedures can also cause increased strain especially on the upper and lower back [\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Relative unfamiliarity with microscope use (for residents) and the greater degree of cervical spine flexion when operating while standing may contribute to head and neck pain [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Similar to the craniotomies, residents reported more pain than consultants [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eComparison between Consultants and Residents\u003c/h2\u003e\u003cp\u003eIn our study, the consultants had lower mean pain scores than residents, despite being older and having more medical and musculoskeletal comorbidities. However, they have been in neurosurgical practice for a longer period of time, and devoted more time to exercise. This suggests that inexperience and lack of exercise may be important factors contributing to work-related musculoskeletal pain. Consultants, who have a mean tenure of 14.6 years, could have developed their technique over time to minimize intraoperative pain. They also have more control over their schedule and more time to rest, compared to residents.\u003c/p\u003e\u003cp\u003eThere are conflicting findings regarding the relationship of tenure to pain. One author reported that neurosurgery trainees and consultants who were more than 11 years into their practice had comparable pain prevalence [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], while another wrote that tenure of more than 15 years was associated with musculoskeletal pain among neurosurgery consultants [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eResidents were more likely to be an assist in the five index procedures, and the pain scores as assist were higher than as primary surgeon. This was logical because the operating field would be biased ergonomically for the primary surgeon. A study on laparoscopic surgery showed that assists had similar and occasionally higher levels of muscle activation compared to primary surgeons, which can lead to ergonomic stress [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOther anatomic regions that were significantly more painful for residents than consultants include the head, eyes, and ankles/feet. One reason may be the lack of experience with magnification equipment (loupes or microscope) causing headache and eye strain. Another possible reason may be the general workload, stress, and lack of sleep associated with residency training, predisposing the resident to headache and eye pain. Younger residents may not be used to lengthy operations, especially in a standing position, leading to pain in the lower extremities. Prolonged standing has been correlated with increased musculoskeletal pain [\u003cspan additionalcitationids=\"CR3 CR4 CR5\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eBehavioral Response to Pain\u003c/h2\u003e\u003cp\u003eThe most common intraoperative responses were adjusting body position or the ergonomics of the surgical field. The most common behavioral response (increased irritability, decreased patience) suggests work-related musculoskeletal pain causes additional social strain that negatively affects the workplace environment [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOnly 9% of respondents considered spending time away from neurosurgery, and 3% considered early retirement. In Ho et al.\u0026rsquo;s study, 1 in 10 otorhinolaryngologists (10%) considered early retirement [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Other authors reported higher numbers, with 30-31.9% of respondents taking time off or retiring due to the work-related musculoskeletal pain [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eRecommendations\u003c/h2\u003e\u003cp\u003eGiven our findings, there is a need to address work-related musculoskeletal pain among neurosurgery consultants and residents. Ergonomic training and educational programs geared towards their health may be instituted to promote better well-being. Physical therapy, exercise, and wellness programs may also be started in order to improve neurosurgeon stamina and tolerance. Adjusting operating schedules to allot time for rest may be helpful in reducing pain. In addition, securing ergonomic operating room equipment and taking a mandatory break during long surgical procedures may be of benefit.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThe study has several limitations. First, as the intent of this survey was to obtain an overview of symptom prevalence and their associated behaviors by neurosurgeons in the Philippines, there was an appreciable selection bias generated by the distribution of the survey and voluntary survey participation. Second, respondents were asked to remember details regarding the onset, degree, and frequency of their symptoms, which was subject to recall bias. Third, workload and stress outside of surgery were not part of the scope of the study, but they may have contributed to the overall work-related musculoskeletal pain of the respondent. Finally, the survey instrument included open-ended responses (top 3 procedures that caused the most pain) that required interpretation and categorization on a case-by-case basis. They were summarized at the end of the results to the best of our capabilities.\u003c/p\u003e\u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eBoth neurosurgery consultants and residents reported work-related musculoskeletal pain. Residents, who are younger and have fewer comorbidities but less experience and less exercise, reported more pain compared to the consultants. The anatomic regions that were most affected were the neck, shoulders, upper back, wrists, and lower back. The procedures with the highest pain scores were SC, IC, and SS, which may be related to the scope of neurosurgery practice in the Philippines. As the first local study on work-related musculoskeletal pain in the Philippine neurosurgical field, this descriptive study contributes to a growing body of literature interested in investigating and promoting policies that can improve the well-being of neurosurgeons, ultimately improving neurosurgical care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAFNI Academy of Filipino Neurosurgeons, Incorporated\u003c/p\u003e\n\u003cp\u003ePANSR Philippine Association of Neurosurgical Residents\u003c/p\u003e\n\u003cp\u003eSC Supratentorial craniotomy\u003c/p\u003e\n\u003cp\u003eIC Infratentorial craniotomy\u003c/p\u003e\n\u003cp\u003eTS Transsphenoidal surgery\u003c/p\u003e\n\u003cp\u003eVPS Ventriculoperitoneal shunt \u003c/p\u003e\n\u003cp\u003eSS Spine surgery\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting Interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthor Contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Sean Kendrich N. Cua, MD, Juan Silvestre G. Pascual, MD, Mary Angeline Luz U. Hernandez, MD, Eric Dennis C. Legaspi, MD, Kathleen Joy O. Khu, MD. The first draft of the manuscript was written by Sean Kendrich N. Cua, MD and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthics Approval\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the University of the Philippines Manila Research Ethics Board (UPMREB) Review Panel 4 (10 June 2024, 2024-0432-01).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent to Participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent to Publish\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors affirm that human research participants provided informed consent for publication of the data provided in the study.\u003c/p\u003e\u003cp\u003eCRediT Author Statement:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConceptualization: Sean Kendrich N. Cua, MD, Juan Silvestre G. Pascual, MD, Mary Angeline Luz U. Hernandez, MD, Eric Dennis C. Legaspi, MD, Kathleen Joy O. Khu, MD; Resource: Sean Kendrich N. Cua, MD, Juan Silvestre G. Pascual, MD, Mary Angeline Luz U. Hernandez, MD, Eric Dennis C. Legaspi, MD, Kathleen Joy O. Khu, MD; Methodology: Sean Kendrich N. Cua, MD, Juan Silvestre G. Pascual, MD, Kathleen Joy O. Khu, MD; Data Curation: Sean Kendrich N. Cua, MD, Juan Silvestre G. Pascual, MD; Formal analysis: Sean Kendrich N. Cua, MD, Juan Silvestre G. Pascual, MD; Writing \u0026ndash; Original Draft Preparation: Sean Kendrich N. Cua, MD, Kathleen Joy O. Khu; Writing \u0026ndash; review and editing: Sean Kendrich N. Cua, MD, Juan Silvestre G. Pascual, MD, Kathleen Joy O. Khu, MD; Visualization: Sean Kendrich N. Cua, MD, Juan Silvestre G. Pascual, MD, Kathleen Joy O. Khu, MD; Validation: Mary Angeline Luz U. Hernandez, MD; Supervision: Eric Dennis C. Legaspi, MD, Kathleen Joy O. Khu, MD; Project Administration: Kathleen Joy O. Khu, MD\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEpstein S, Sparer EH, Tran BN, et al. (2018) Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists: A Systematic Review and Meta-analysis. \u003cem\u003eJAMA Surg\u003c/em\u003e. 153(2):e174947. doi:10.1001/jamasurg.2017.4947\u003c/li\u003e\n\u003cli\u003eMavrovounis G, Meling TR, Lafuente J, Fountas KN, Demetriades AK. (2021) Postural ergonomics and work-related musculoskeletal disorders in neurosurgery: lessons from an international survey. \u003cem\u003eActa Neurochir (Wien)\u003c/em\u003e 163(6):1541-1552. doi:10.1007/s00701-021-04722-5\u003c/li\u003e\n\u003cli\u003eMcQuivey KS, Deckey DG, Christopher ZK, et al. (2021) Surgical Ergonomics and Musculoskeletal Pain in Orthopaedic Surgery Residents: A Multicenter Survey Study. \u003cem\u003eJ Am Acad Orthop Surg Glob Res Rev\u003c/em\u003e. 5(3):e20.00119. Published 2021 Mar 11. doi:10.5435/JAAOSGlobal-D-20-00119\u003c/li\u003e\n\u003cli\u003eGadjradj PS, Ogenio K, Voigt I, Harhangi BS. (2020) Ergonomics and Related Physical Symptoms Among Neurosurgeons. \u003cem\u003eWorld Neurosurg\u003c/em\u003e. 134:e432-e441. doi:10.1016/j.wneu.2019.10.093\u003c/li\u003e\n\u003cli\u003eLav\u0026eacute; A, Gondar R, Demetriades AK, Meling TR. (2020) Ergonomics and musculoskeletal disorders in neurosurgery: a systematic review. \u003cem\u003eActa Neurochir (Wien)\u003c/em\u003e. 162(9):2213-2220. doi:10.1007/s00701-020-04494-4\u003c/li\u003e\n\u003cli\u003eAuerbach JD, Weidner ZD, Milby AH, Diab M, Lonner BS. (2011) Musculoskeletal disorders among spine surgeons: results of a survey of the Scoliosis Research Society membership. \u003cem\u003eSpine (Phila Pa 1976)\u003c/em\u003e. 36(26):E1715-E1721. doi:10.1097/BRS.0b013e31821cd140\u003c/li\u003e\n\u003cli\u003eSchupper AJ, Hrabarchuk EI, McCarthy L, Hadjipanayis CG. (2023) Improving Surgeon Well-Being: Ergonomics in Neurosurgery. \u003cem\u003eWorld Neurosurg\u003c/em\u003e. 175:e1220-e1225. doi:10.1016/j.wneu.2023.04.102\u003c/li\u003e\n\u003cli\u003eWyatt RW, Lin CC, Norheim EP, Przepiorski D, Navarro RA. (2020) Occupation-related Cervical Spine Disease in Orthopaedic Surgeons. \u003cem\u003eJ Am Acad Orthop Surg\u003c/em\u003e. 28(17):730-736. doi:10.5435/JAAOS-D-19-00834\u003c/li\u003e\n\u003cli\u003eSvebak S, Halvari H. (2018) Sickness Absence due to Chronic Musculoskeletal Pain: The Exploration of a Predictive Psychological Model Including Negative Moods, Subjective Health and Work Efficacy in an Adult County Population (The HUNT Study). \u003cem\u003eEur J Psychol\u003c/em\u003e. 14(2):373-385. Published 2018 Jun 19. doi:10.5964/ejop.v14i2.1470\u003c/li\u003e\n\u003cli\u003eWright ME. (1997) Long-term sickness absence in an NHS teaching hospital. \u003cem\u003eOccup Med (Lond)\u003c/em\u003e. 47(7):401-406. doi:10.1093/occmed/47.7.401\u003c/li\u003e\n\u003cli\u003ede Paiva LG, Dalmolin GL, Dos Santos WM. (2021) Absenteeism-disease in health care workers in a hospital context in southern Brazil. \u003cem\u003eRev Bras Med Trab\u003c/em\u003e. 18(4):399-406. Published 2021 Mar 3. doi:10.47626/1679-4435-2020-521\u003c/li\u003e\n\u003cli\u003eHafner ND, Milek DM, Fikfak MD. (2018) Hospital Staff\u0026apos;s Risk of Developing Musculoskeletal Disorders, Especially Low Back Pain. \u003cem\u003eZdr Varst\u003c/em\u003e. 57(3):133-139. Published 2018 Jun 21. doi:10.2478/sjph-2018-0017\u003c/li\u003e\n\u003cli\u003eWohlauer M, Coleman DM, Sheahan MG, et al. (2021) Physical pain and musculoskeletal discomfort in vascular surgeons. \u003cem\u003eJ Vasc Surg\u003c/em\u003e. 73(4):1414-1421. doi:10.1016/j.jvs.2020.07.097\u003c/li\u003e\n\u003cli\u003eBorg G. (1990) Psychophysical scaling with applications in physical work and the perception of exertion. \u003cem\u003eScand J Work Environ Health\u003c/em\u003e. 16 Suppl 1:55-58. doi:10.5271/sjweh.1815\u003c/li\u003e\n\u003cli\u003eAcademy of Filipino Neurosurgeons, Inc. (2024) Landing Page - Academy of Filipino Neurosurgeons, Inc. Academy of Filipino Neurosurgeons, Inc. Published May 17, 2024. Accessed October 21, 2024. https://www.afninc.org\u003c/li\u003e\n\u003cli\u003eGBD 2021 Low Back Pain Collaborators. (2021) Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study \u003cem\u003eLancet Rheumatol\u003c/em\u003e. 2023;5(6):e316-e329. Published 2023 May 22. doi:10.1016/S2665-9913(23)00098-X\u003c/li\u003e\n\u003cli\u003eFerguson R, Riley ND, Wijendra A, Thurley N, Carr AJ, Bjf D. (2019) Wrist pain: a systematic review of prevalence and risk factors- what is the role of occupation and activity?. \u003cem\u003eBMC Musculoskelet Disord\u003c/em\u003e. 20(1):542. Published 2019 Nov 14. doi:10.1186/s12891-019-2902-8\u003c/li\u003e\n\u003cli\u003eNiemel\u0026auml;inen R, Videman T, Batti\u0026eacute; MC. (2006) Prevalence and characteristics of upper or mid-back pain in Finnish men. \u003cem\u003eSpine (Phila Pa 1976)\u003c/em\u003e. 31(16):1846-1849. doi:10.1097/01.brs.0000226022.05420.1f\u003c/li\u003e\n\u003cli\u003eBaticulon RE, Lucena LLN, Gimenez MLA, Sabalza MN, Soriano JA. (2024) The Neurosurgical Workforce of the Philippines. \u003cem\u003eNeurosurgery\u003c/em\u003e. 94(1):202-211. doi:10.1227/neu.0000000000002630\u003c/li\u003e\n\u003cli\u003eTanaka SA, Patel NM, Murthy AS. (2020) No Longer a Pain in the Neck: Use of Operating Microscope for Palatoplasty. \u003cem\u003ePlast Reconstr Surg Glob Open\u003c/em\u003e. 8(10):e3196. Published 2020 Oct 29. doi:10.1097/GOX.0000000000003196\u003c/li\u003e\n\u003cli\u003eZihni AM, Cavallo JA, Ray S, Ohu I, Cho S, Awad MM. (2016) Ergonomic analysis of primary and assistant surgical roles. \u003cem\u003eJ Surg Res\u003c/em\u003e. 203(2):301-305. doi:10.1016/j.jss.2016.03.058\u003c/li\u003e\n\u003cli\u003eHo TT, Hamill CS, Sykes KJ, Kraft SM. (2018) Work-related musculoskeletal symptoms among otolaryngologists by subspecialty: A national survey. \u003cem\u003eLaryngoscope\u003c/em\u003e. 128(3):632-640. doi:10.1002/lary.26859\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"neurosurgical-review","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nrev","sideBox":"Learn more about [Neurosurgical Review](https://www.springer.com/journal/10143)","snPcode":"10143","submissionUrl":"https://submission.nature.com/new-submission/10143/3","title":"Neurosurgical Review","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Musculoskeletal pain, neurosurgery, ergonomics","lastPublishedDoi":"10.21203/rs.3.rs-6966022/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6966022/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWork-related musculoskeletal pain has become a growing concern in the practice of neurosurgery.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional online survey study was conducted among neurosurgery consultants and residents in the Philippines. The survey was adapted from previously published literature on work-related musculoskeletal pain in surgical specialties, and consisted of questions for demographic data, case load, operating room ergonomics, and the Borg pain scale for five index neurosurgical operations: supratentorial craniotomy (SC), infratentorial craniotomy (IC), transsphenoidal surgery (TS), ventriculoperitoneal shunt (VPS) insertion, and spine surgery (SS).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA total of 100 respondents (56 consultants and 44 residents) were obtained, with a response rate of 46% (100/217). The mean pain scores were greater in residents than consultants across all anatomic regions and index operations. For consultants, the greatest prevalence of pain was found at the neck (SC 76.8%, IC 89.3%, TS 69.6%, VPS 33.9%, and SS 71.4%). For residents, it was at the lower back (SC 84.1%, IC 86.4%, TS 75.0%, VPS 47.7%, and SS 79.5%). The most common intraoperative response was to stretch or change the height of the neurosurgical field or microscope angulation, while the most common behavioral response was increased irritability and decreased patience.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eDiscussion\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eConsultants, who are older and have more medical and musculoskeletal comorbidities, but have more experience in the practice of neurosurgery and more time devoted to exercise, had lower pain scores than residents. Future studies can be geared towards instituting ergonomic training and educational programs for consultant and resident health.\u003c/p\u003e","manuscriptTitle":"Prevalence of work-related musculoskeletal pain among neurosurgeons and trainees in the Philippines","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-07 09:05:16","doi":"10.21203/rs.3.rs-6966022/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-13T15:56:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-15T07:46:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-12T14:08:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-10T11:17:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"145428867652533305228530921576185962573","date":"2025-08-05T19:56:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"290745285174482172700120604957274995038","date":"2025-08-05T17:07:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-03T17:58:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"135023775700807883006217894689729282930","date":"2025-08-03T17:42:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336773330157924562067602497162162784270","date":"2025-08-03T16:11:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-03T16:06:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-03T16:04:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-27T06:48:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"Neurosurgical Review","date":"2025-06-24T13:00:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"neurosurgical-review","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nrev","sideBox":"Learn more about [Neurosurgical Review](https://www.springer.com/journal/10143)","snPcode":"10143","submissionUrl":"https://submission.nature.com/new-submission/10143/3","title":"Neurosurgical Review","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"20f39de6-956b-4493-8c51-0691e01a06db","owner":[],"postedDate":"August 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T16:08:45+00:00","versionOfRecord":{"articleIdentity":"rs-6966022","link":"https://doi.org/10.1007/s10143-025-04017-8","journal":{"identity":"neurosurgical-review","isVorOnly":false,"title":"Neurosurgical Review"},"publishedOn":"2026-01-10 15:58:19","publishedOnDateReadable":"January 10th, 2026"},"versionCreatedAt":"2025-08-07 09:05:16","video":"","vorDoi":"10.1007/s10143-025-04017-8","vorDoiUrl":"https://doi.org/10.1007/s10143-025-04017-8","workflowStages":[]},"version":"v1","identity":"rs-6966022","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6966022","identity":"rs-6966022","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}