Provaggi, E;
Capelli, C;
Leong, J;
Kalaskar, D;
(2018)
A UK-based pilot study of current surgical practice and implant preferences in lumbar fusion surgery.
Medicine
, 97
(26)
, Article e11169. 10.1097/MD.0000000000011169.
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Abstract
Lumbar fusion surgery is an established procedure for the treatment of low back pain. Despite the wide set of alternative fusion techniques and existing devices, uniform guidelines are not available yet and common surgical trends are scarcely investigated. The purpose of this UK-based study was to provide a descriptive portrait of current surgeons' practice and implant preferences in lumbar fusion surgery. A UK-based in-person survey was designed for this study and submitted to a group of consultant spinal surgeons (n=32). 15 queries were addressed based on different aspects of surgeons' practice: lumbar fusion techniques, implant preferences, and bone grafting procedures. Answers were analysed by means of descriptive statistics. 32 consultant spinal surgeons completed the survey. There was clear consistency on the relevance of a patient-centred management (82.3%), along with a considerable variability of practice on the preferred fusion approach. Fixation surgery was found to be largely adopted (96.0%) and favoured over stand-alone cages. With regards to the materials, titanium cages were the most used (54.3%). The geometry of the implants influenced the choice of lumbar cages (81.3%). Specifically, parallel-shape cages were mostly avoided (89.2%) and hyperlordotic cages were preferred at the lower lumbar levels. However, there was no design for lumbar cages which was consistently favoured. Autograft bone graft surgeries were the most common (60.0%). Amongst the synthetic options, hydroxyapatite-based bone graft substitutes (76.7%) in injectable paste form (80.8%) were preferred. Current lumbar fusion practice is variable and patient-oriented. Factors such as design and materials are crucial in the choice of the interbody fusion implant. Findings from this study highlight the need for large-scale investigative surveys and clinical studies aimed to set specific guidelines for certain pathologies or patient categories.
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