Minimally Invasive 2D Navigation-Assisted Treatment of Thoracolumbar Spinal Fractures in East Africa: A Case Report

Abstract

Spinal surgery under Eastern-African circumstances is technically demanding and associated with significant complications, such as blood loss, infection, and wound breakdown. We report a spinal trauma case that was performed using minimally invasive surgery (MIS) and navigation, and hypothesize that these newer techniques may enable surgeons to perform effective spinal surgery with minimal complications and good outcomes. During the 2014 First Hands-on Neurotrauma Course held in Dar es Salaam, Tanzania, we successfully performed three minimally invasive and two-dimensional (2D) navigated spinal surgeries to decompress and stabilize patients with complete and incomplete spinal injuries. In this report, we present a case of a paraplegic patient with a T12 burst fracture who tolerated MIS surgery with no intraoperative complications, and is doing well with no postoperative complications one year after surgery.Minimally invasive spinal surgery and 2D navigation may offer advantages in resource-poor countries. As part of the Weill Cornell Tanzania Neurosurgery project and in conjunction with the Foundation for International Education in Neurological Surgery (as well as other organizations), further experiences with 2D navigation and MIS surgery will be recorded in 2015. A neurotrauma registry has already been implemented to better understand the current management of neurotrauma in Eastern Africa.

Titanium Clamps for a Simple Low-Profile Autologous Osteosynthesis in the Reconstruction of Posttraumatic Craniofacial Convexital Skeletal Disruption

“…Increasingly, an understanding of the issues at play and an application of appropriate preemptive measures to forestall these challenges have since begun to open up new horizons of possibilities in this regard. 6 This study is a practical demonstration of this fact from a developing sub-Sahara African country. A biomaterial, the titanium clamp (CranioFix), has been successfully implanted for the reconstruction of PTCD in a prospective, consecutive series of patients over a period of more than 6 years.…”

“…But the situation needs not remain so permanently, and certainly not absolutely. Increasingly, an understanding of the issues at play and an application of appropriate preemptive measures to forestall these challenges have since begun to open up new horizons of possibilities in this regard 6. This study is a practical demonstration of this fact from a developing sub-Sahara African country.…”

“…In the face of the shortage of the appropriate technological backup, and an overall poor health infrastructure in general, there are usually strong concerns, indeed reservations, about instrumentation neurosurgery in developing countries. 6,7 This is specifically as regards possible postoperative complications not the least of which is SSI. But the situation needs not remain so permanently, and certainly not absolutely.…”

Feasibility of High-Fidelity Simulator Models for Minimally Invasive Spine Surgery in a Resource-Limited Setting: Experience From East Africa

“…One of the challenges is due to the limitation of training facilities in such settings: the need is greater than the available facilities. 15 Simulation-based surgical training has been useful in the acquisition of skills; however, there have been questions on the transferability of the skills acquired to the real patient and surgery. 7 Synthetic spine models have been used for years but often only for learning pedicle screw placement.…”

Evolving Navigation, Robotics, and Augmented Reality in Minimally Invasive Spine Surgery

“…Despite an increase in setup time attributed to the novelty of devices used, there was near complete elimination of detectable radiation exposure to the patient and staff. 10 Njoku et al 11 utilized the 2D Kick system (BrainLab AG, Munich, Germany) for percutaneous stabilization of a traumatic burst fracture (Figure 3), and furthermore explored its use in developing countries that are technologically limited in the present day, such as Tanzania. 11…”