Provaggi Elena, Capelli Claudio, Leong Julian J H, Kalaskar Deepak M
UCL Institute of Orthopaedics and Musculoskeletal Science Centre for Nanotechnology and Regenerative Medicine, Division of Surgery & Interventional Science Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, University College London (UCL), London, United Kingdom Royal National Orthopedic Hospital, Brockley Hill, Stanmore, Middlesex, United Kingdom.
Medicine (Baltimore). 2018 Jun;97(26):e11169. doi: 10.1097/MD.0000000000011169.
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). Fifteeen queries were addressed based on different aspects of surgeons' practice: lumbar fusion techniques, implant preferences, and bone grafting procedures. Answers were analyzed by means of descriptive statistics.Thirty-two consultant spinal surgeons completed the survey. There was clear consistency on the relevance of a patient-centered 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 favored 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 favored. 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. 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.
腰椎融合手术是治疗下腰痛的一种既定手术方法。尽管有多种替代融合技术和现有器械，但尚未有统一的指南，且常见的手术趋势也鲜有研究。这项基于英国的研究旨在描述当前外科医生在腰椎融合手术中的实践情况和植入物偏好。本研究设计了一项基于英国的面对面调查，并提交给一组脊柱外科顾问医生（n = 32）。基于外科医生实践的不同方面提出了15个问题：腰椎融合技术、植入物偏好和骨移植手术。通过描述性统计分析答案。32位脊柱外科顾问医生完成了调查。在以患者为中心的管理的相关性方面存在明显的一致性（82.3%），同时在首选融合方法上的实践存在相当大的差异。发现固定手术被广泛采用（96.0%），且比单独使用椎间融合器更受青睐。关于材料，钛制椎间融合器使用最多（54.3%）。植入物的几何形状影响腰椎椎间融合器的选择（81.3%）。具体而言，大多避免使用平行形状的椎间融合器（89.2%），在下腰椎节段更倾向使用前凸椎间融合器。然而，没有一种腰椎椎间融合器的设计一直受到青睐。自体骨移植手术最为常见（60.0%）。在合成材料选项中，首选注射膏状的基于羟基磷灰石的骨移植替代物（76.7%），其呈注射膏状的比例为80.8%。当前的腰椎融合实践是多样的且以患者为导向。这项研究的结果凸显了开展大规模调查研究和临床研究的必要性，旨在为某些病理情况或患者类别制定具体指南。
