Global Spine Implant Access

In many countries, particularly low and middle-income countries, patients and their families have to purchase their own screws and rods for spinal surgery. One of our contributors, Kelly, faced this exact challenge when she needed spine surgery in Venezuela. Her family was instructed on what to buy and how to buy it in a process with significant country-to-country variation. Enuval has found that patients globally often face enormous barriers to accessing implants for needed surgeries, and we have worked to better describe these barriers toward overcoming them in the future.

Above is a photo of an x-ray showing rods and screws (in white) that hold the spine in position while it’s healing. These implants are often critical to spine surgery. Many patients globally have to purchase their own implants for surgery, and this presents a major barrier to care.

In order to better understand how patients obtain implants globally, we engaged a core group of our members to help gather narrative information from surgeons about how patients procure implants for surgery. Through our members' outreach via various social media channels, we conducted brief interviews with surgeons practicing in South America. We found that in approximately one-third of countries, a major proportion of patients were responsible for their own implant purchase.

The countries where some patients were responsible for implant purchases usually had a lower gross domestic product and/or income per capita. Some surgeons felt that this purchase represented a significant financial burden for patients and a major barrier to care. Many noted that it was usually patients least able to afford implants that often had to procure their own implants. Wealthier patients, in many cases, had access to private insurance that relieved the financial burden of implant purchases.

Given that this was an inaugural project, we also involved a core group of women with a personal history of spine conditions, who developed research skills all the way from hypothesis generation to data gathering to analysis and writing. The complete findings are in final preparation for submission to publication.

We hope to gain more granular information on the hurdles to obtaining surgical care, not just in South America, but globally. The goal is to better shed light on some of the pragmatic issues facing those requiring spine surgery in the hope of extending spine care access.

During the course of this work, we also found that the implants being purchased by patients were of various brands, often not carefully evaluated by a central regulatory agency. This led to our second investigation about Global Implant Quality.

Our research team discussion with Martha and Sariah. All participants engaged in this project have scoliosis or other spine conditions themselves, and for most, this was their first time engaging in research.

Two photos showing a market stall in Myanmar where patients can purchase their own implants for surgery.