Life cycle assessment of a disposable and a reusable surgery instrument set for spinal fusion surgeries

Leiden A, Cerdas F, Noriega D, Beyerlein J, Herrmann C. Life cycle assessment of a disposable and reusable surgery instrument set for spinal fusion surgeries. Resources, Conservation & Recycling 156 (2020) 104704.


  • Compares environmental impact of a reusable and a disposable spinal fusion instruments set.
  • Sterilization drives the environmental impact of surgery instruments set.
  • Disposable sets can have environmental benefits.
  • Future development of surgical instrument set should consider environmental impact.


The worldwide increasing wealth and increased life expectancy of humans has led to an increase in the number of medical procedures and surgeries. Surgeries are complex medical procedures which contribute to a significant share of the total environmental impact of the healthcare system. Among other important sources of environmental impacts from surgeries, material consumption due to required instrumentation accounts for up to 65 % of greenhouse gas emissions from surgeries. This study investigates how a disposable and a reusable surgery instrument sets for lumbar fusion surgeries contribute to the environmental impact and which system is more advantageous for the environment. For lumbar fusion surgeries, reusable and disposable instrumentation and implant sets are commercially available. Both sets are capable to support a one level lumbar fusion surgery. The reusable set is comprehensive and fully opened before the surgery, while the disposable system comes in a modular box system, and the boxes are opened on demand during the surgery. To compare the environmental impact of these different configurations, a comparative Life Cycle Assessment (LCA) was performed to assess the overall environmental impacts of both alternatives. One of the key findings is that the selected cleaning and sterilization process for reusable instruments is responsible for up to 90 % of the greenhouse gas emissions and decides which system is advantageous from an environmental perspective. Reducing the number of instruments to be cleaned and sterilized for a surgery should be the focus for future surgery instruments development from an environmental perspective.

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