Clinical efficacy of non-standard spine surgery implants in Malawi’s challenging environment

To evaluate the clinical efficacy of using non-standard spinal implants by the China Medical Team in the treatment of spinal diseases in Malawi, a resource-limited setting. A retrospective analysis was performed on 120 patients who had spine surgery in Kamuzu Central Hospital in Lilongwe, Malawi, from December 2022 to January 2024. Disease types, surgical approaches, and the non-standard spinal implants used were recorded. Pain was assessed using the Visual Analogue Scale (VAS), and functional status using the Oswestry Disability Index (ODI). Imaging was used to evaluate implant position, spinal stability, and bone fusion. Intraoperative and postoperative complications were also recorded. The 120 patients (69 males, 51 females; mean age 50.6 ± 10.4 years) included 58 with degenerative disease, 44 with spinal fractures, and 18 with spinal infections. Thirty-one patients underwent anterior-only, 63 posterior-only, and 26 combined anterior–posterior procedures. VAS and ODI scores improved significantly during follow-up. Most implants remained in a satisfactory position, with maintained spinal stability. One patient had a plate breakage 4 months after surgery. At 6 months, about 80% of patients had radiological evidence of fusion, and by 1 year all but the patient with plate breakage had achieved bony union. No severe intraoperative or postoperative complications occurred; five patients had mild infections that resolved with antibiotics. In a resource-limited environment, using alternative spinal internal fixation implants may be a feasible option. However, definitive conclusions on safety and efficacy cannot be drawn due to the study's retrospective design, small sample size, and lack of a control group. Future prospective, controlled studies are needed to validate these findings before broader application.