A cohort of minimally invasive spine surgeries in Nigeria

Abstract Minimally invasive spine surgery (MISS) has gained traction since its introduction into the spine surgery armamentarium, resulting in better outcomes than the traditional open approaches. It was only recently introduced in Nigeria, where it is rarely performed. In a bid to improve access to state-of-the-art neurosurgical services in his home country, the lead author, having practiced MISS in the United States, started performing it in Nigeria in 2017. We aim to describe our MISS experience in Nigeria, a lower-middle-income country (LMIC) with high poverty indices. This is a retrospective review of our database of patients who had MISS for degenerative spine disease involving the thoracic, lumbar, and lumbosacral spine regions from April 2017 to May 2022. Demographic, perioperative, and patient-reported outcome data were retrieved and analyzed (statistical significance—p < 0.05). The same lead surgeon performed the procedures with similar operative techniques and perioperative management. The data of the 143 patients were not normally distributed. The median age was 62 years and males comprised 55.9%. About half the patients had minimally invasive (MIS) laminectomy; 45.5% and 3.5% had MIS-transforaminal lumbar interbody fusion (TLIF) and MIS-microdiscectomy, respectively. Most (73.4%) were in the lumbar spine, 25.2% involved the lumbosacral junction, and 1.4% were in the thoracic spine. Median surgery duration, estimated blood loss, and length of hospital stay were 112 mins, 50 cubic centimeters, and 3 days, respectively. The overall perioperative complication rate was 6.3%, while surgical complications occurred in 4.9% of the patients. The patient-reported outcomes (Numeric Rating Scale [NRS] scores and Oswestry Disability Index [ODI]) showed minimal important differences (MID) between baseline and one-year follow-up. This study’s perioperative parameters and complication (overall and specific) rates are comparable to those obtained from previous work on MIS lumbar decompression (laminectomy and microdiscectomy) and TLIF in higher-income countries. TLIF, whether open or minimally invasive, is more invasive, destructive, and technically demanding than decompression. It is, therefore, not surprising that MIS-TLIF resulted in statistically higher SDn, EBL, and LOS than MIS-decompression. The higher incidence of complications in MIS-TLIF compared with MIS-decompression is also not unexpected because of the instrumentation and implants involved in MIS-TLIF. In the same vein, it is unsurprising that patients who underwent MIS-TLIF had statistically higher discharge to inpatient physical therapy rates and lower discharge home rates than those who underwent MIS-decompression. The improvement between median NRS and ODI scores at the preoperative evaluation and one year after surgery were either comparable to or exceeded the MID in these patient-reported outcomes demonstrated in previous research—a two-point change for NRS and a 5.9–20 difference for ODI. Our efforts to introduce MISS as part of our practice in Nigeria are informed by the need for deploying, developing, and maintaining beneficial cutting-edge care in LMICs where the capacity exists while not neglecting the ‘stock’ procedures. MISS is available in Nigeria, and it is characterized in our practice by satisfactory patient-reported outcomes and comparable perioperative parameters and complication rates to those obtained from MISS performed in countries with higher incomes than Nigeria, where MISS is rife.