Changing Trends and Challenges of Spine Surgery in a Developing Country

Chikani, Mark C; Matthew, Mesi; Okwunodulu, Okwuoma; Mezue, Wilfred C; Ohaegbulam, Samuel C.; Ndubuisi, Chika Anele; Iroegbu, L; Nkwerem, Sunday

doi:10.1016/j.wneu.2019.06.229

Cited by 10 publications

(7 citation statements)

References 18 publications

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“…Lastly, scoliosis surgery is limited in middle-low-income countries, and although AVBT is still growing as an alternative for scoliosis correction, an open AVBT approach has the potential to be replicated in a low-resource setting where thoracoscopic technology may not be available. 38,39 This study is not without limitations. Firstly, this study is limited by its sample size and retrospective design.…”

Section: Discussionmentioning

confidence: 94%

“…An open approach also yields direct visualization of muscle nerve innervation, which minimizes the risk of long thoracic or thoracodorsal nerve injuries. Lastly, scoliosis surgery is limited in middle-low-income countries, and although AVBT is still growing as an alternative for scoliosis correction, an open AVBT approach has the potential to be replicated in a low-resource setting where thoracoscopic technology may not be available 38,39…”

Section: Discussionmentioning

confidence: 99%

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Perioperative Outcomes of Open Anterior Vertebral Body Tethering and Instrumented Posterior Spinal Fusion for Skeletally Immature Patients With Idiopathic Scoliosis

Siu

Saggi

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Correcting adolescent idiopathic scoliosis (AIS) without fusion can be achieved with anterior vertebral body tethering (AVBT). However, little is known about the perioperative outcomes, pain control, and clinical outcomes in patients undergoing AVBT compared with instrumented posterior spinal fusion (IPSF). Methods: In this retrospective cohort study, we compared pediatric patients with AIS who underwent either AVBT or IPSF. Inclusion criteria were based on the AVBT group, which included primary thoracic idiopathic scoliosis, Risser ≤1, curve magnitude 40 to 70 degrees, age 9 to 15, no prior spine surgery, index surgery between 2014 and 2019, and minimum 2-year follow-up. Patient demographics, perioperative metrics, pain visual analog scale scores, opiate morphine equivalent usage, cost data, and radiographic outcomes were compared. Results: We identified 23 patients who underwent AVBT and 24 matched patients in the IPSF group based on inclusion criteria. Patients undergoing AVBT and PSF were similar in age (12±1 y vs. 13±1 y, P=0.132) and average follow-up time (3.8±1.6 y vs. 3.3±1.4 y, P=0.210). There were 23 female patients (87%) in the AVBT group and 24 female (92%) patients in the IPSF group. Intraoperatively, estimated blood loss (498±290 vs. 120±47 mL, P<0.001) and procedure duration (419±95 vs. 331±83 min, P=0.001) was significantly greater in the IPSF group compared with AVBT. Length of stay was lower in the AVBT group compared with PSF (4±1 vs. 5±2 d, P=0.04). PSF patients had significantly greater total postoperative opiate morphine equivalent use compared with AVBT (2.2±1.9 vs. 5.6±3.4 mg/kg, P<0.001). Overall direct costs following PSF and AVBT were similar ($47,655+$12,028 vs. $50,891±$24,531, P=0.58). Preoperative radiographic parameters were similar between both the groups, with a major thoracic curve at 51±10 degrees for AVBT and 54±9 degrees for IPSF (P=0.214). At the most recent follow-up, IPSF patients had greater curve reduction to a mean major thoracic curve of 11±7 degrees (79%) compared with 19±10 degrees (63%) in AVBT patients (P=0.002). Nine patients (39%) required revision surgery following AVBT compared with 4 patients(17%) following IPSF (P=0.09). Conclusions: In a select cohort of patients, AVBT offers decreased surgical time, blood loss, length of stay, and postoperative opiate usage compared with IPSF. Although IPSF resulted in greater deformity correction at 2-year follow-up, the majority of patients who underwent AVBT had ≤35 major curves and avoided fusion. There is optimism for AVBT as a treatment option for select AIS patients, but long-term complications are still being understood, and the risk for revision surgeries remains high. Level of Evidence: Level III.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Perioperative Outcomes of Open Anterior Vertebral Body Tethering and Instrumented Posterior Spinal Fusion for Skeletally Immature Patients With Idiopathic Scoliosis

Siu

Saggi

et al. 2022

Journal of Pediatric Orthopaedics

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“…Spine surgery in low-income countries faces significant challenges, with availability of proper equipment one of the prominent issues. 29 As the mirrors described here are low-cost and reusable, they could conceivably help to enhance patient safety and anesthesia provider comfort in during prone surgeries in low resource settings.…”

Section: Discussionmentioning

confidence: 99%

Extendable mirrors to improve anesthesia provider comfort for eye and positioning checks in prone patients: A pilot study

Lin

Bailey

Nguyen

et al. 2020

Journal of Patient Safety and Risk Management

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Prone positioning is frequently used for spinal surgery and is associated with risks including perioperative visual loss and stroke. Frequent eye checks and careful neck positioning are recommended. In our hospital’s current model, anesthesia providers are required to kneel on the operating room floor beneath operating room table, exposing themselves to hazards such as bodily fluids and back and knee strain. This maneuver is both time consuming and unpleasant. While new devices that enable easier visualization of patients in the prone position exist, they are costly and not universally compatible with all operating room tables. Our objective for this feasibility pilot study was to determine if simple, extendable mirrors increase anesthetist comfort during these cases. A nonrandomized survey-based feasibility pilot study was performed, evaluating comfort while performing eye checks with extendable lighted mirrors compared to the standard kneeling practice. A total of 41 nurse anesthetists and anesthesiology residents were analyzed. A mixed model logistic regression demonstrates a three-fold improvement in comfort with the prone position after mirror use (OR = 3.34; 95% CI: 1.06–10.48; p = 0.039). The frequency of eye checks did not change significantly with introduction of the mirror. Use of the extendable mirror improves anesthesia provider comfort with patients in the prone position. We postulate that it may be a useful addition to our practice.

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“…The literature on these neoplasms in the Nigerian paediatric population is indeed sparse. Chikani et al [16] in their large series on the changing trends and challenges of spine surgery in a developing country documented their experience with 463 spine surgeries in a Nigerian neurosurgical facility. Fifty-three (11.4%) of these cases were neoplastic and 1.5% involved spine surgeries in paediatric patients.…”

Section: Discussionmentioning

confidence: 99%

Paediatric Spinal Tumours: Profile and Treatment Outcome in a Nigerian Tertiary Institution

et al. 2021

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Introduction Paediatric spinal tumours are rare, accounting for 1-10% of all childhood central nervous system tumours. There is a paucity of information on spinal tumours in Sub-Saharan Africans. This is particularly so in the Nigerian paediatric population where neuro-oncologic data is limited. Indeed, there is no previously published work on the profile of paediatric spinal tumours in the Nigerian neurosurgical literature. The authors aim to document the profile of paediatric spinal tumours in a Nigerian tertiary institution and to contribute to the available data on paediatric central nervous system tumours in West Africa. Methods We retrospectively evaluated data on paediatric patients who underwent surgery for spine tumours over a 20-year-period at our institution. Results A total of 12 patients were managed for paediatric spine tumours during the study period. These had a male: female ratio of 1:1.4 and their ages ranged between 3 and 18 years (mean: 12.83 ± 4.75 years). The highest incidence (6/12) was seen in the 15-18 years age group. The mean duration of symptoms was 10.2 months. More than half (7/12) of the patients presented with symptoms with duration of at least 6 months. Motor deficit was present in all patients at presentation. Two-thirds of the tumours were in the thoracic region, 1 was located in the cervical region, while the remaining 3 tumours were cervicothoracic. The tumour was extradural in location in 8 of our patients and intramedullary in the remaining 4. Astrocytoma (intramedullary in all cases) was the most predominant histological tumour type in (3/12) in our series. Postoperative neurological improvement occurred in 7 of the patients while 5 remained the same. There was no permanent postoperative neurological deterioration or perioperative mortality. Conclusion Paediatric spinal tumours mostly affected older children in our study group and were predominantly astrocytic in nature. The most common tumour location was extradural, involving mostly the thoracic spinal level. The preoperative neurological status correlates with the postoperative functional outcome. Therefore, the need for early diagnosis and treatment of these tumours cannot overemphasized.

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Changing Trends and Challenges of Spine Surgery in a Developing Country

Cited by 10 publications

References 18 publications

Perioperative Outcomes of Open Anterior Vertebral Body Tethering and Instrumented Posterior Spinal Fusion for Skeletally Immature Patients With Idiopathic Scoliosis

Perioperative Outcomes of Open Anterior Vertebral Body Tethering and Instrumented Posterior Spinal Fusion for Skeletally Immature Patients With Idiopathic Scoliosis

Extendable mirrors to improve anesthesia provider comfort for eye and positioning checks in prone patients: A pilot study

Paediatric Spinal Tumours: Profile and Treatment Outcome in a Nigerian Tertiary Institution

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