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A pain in the back?, By Dr. Biodun Ogungbo Zitadel

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We were in Portharcourt last week to perform an operation at the new Zitadel Medical and Diagnostic Centre. The team flew into Portharcourt overnight and performed Lumbar spine decompression and pedicle screw fixation on a 50 year old man. The operation was accomplished successfully and the patient is recovering well.
There are two reasons why this is important.

Do and die?
First, when we conducted the clinic in Portharcourt to see patients with back and neck pains, we felt a palpable fear of spine surgery among the people who required surgery.
Many people are scared stiff of spine operations in Nigeria and expressed the belief that spine operations were a 50/50 affair. Many said they have heard that patients die or are paralysed after spine surgery and so preferred conservative management. A do and die affair! Yet, many were actually suffering with abysmal quality of life. A patient asked us to speak to her daughter, a medical doctor, who also expressed the same fear.
So even doctors who should know better are afraid to subject their relatives to spine surgery.

Ageist?
The other major concern for patients and relatives is the age of the patient. Some consider anyone above 55 as too old for spine surgery and similarly, anyone below 30, as too young. A misconception, of course. Age has little to do with spine surgery. We can operate on any deserving person so long as there is a good reason for surgery and they are medically fit to undergo the operation.
They have to be assessed and certified fit for the operation and the type of anaesthesia that may be required. We also try to ensure that the real benefits of the operation outweighs the possible side effects inherent in the operation. Finally, we have to be sure we can provide a safe environment for the patient to have a successful procedure.

Neck pain
The very first patient we operated at the hospital had back surgery under local anaesthesia. She was 65 year old and did well following the procedure. The case for last week was a 50 year old man with severe back pains, leg pain, weakness of the legs and difficulty walking. He cannot stand for long, sit for long and certainly cannot run. He was effectively disabled by arthritis in the back and has to be careful in moving around lest he falls down, unable to get up.
The MRI scan of the back showed severe arthritis in the back and significant pressure on the nerves. You see, the nerves were being pressed upon by new bone and thickened ligaments. The nerves move the legs and allow us to feel sensations. The nerves also control the bladder and bowel so some patients have difficulty passing urine and stool.

Operation
We offered him an operation to remove the pressure on the nerves and prevent further damage to them. He was admitted and so we performed this major operation right in the heart of Rivers State. This is the second time a three level spine fixation was performed in the state. The first operation was performed on a 70 year old woman with good recovery.

Information
This article serves to provide current information for the general public and especially medical doctors including orthopedic surgeons and physiotherapists. Spine operations have improved in quality and we now boast of much better outcomes than before. Continuing conservative management in a patient that is visibly deteriorating should no longer be tolerated.
There are now skilled operators in many centres in Nigeria notably in Abuja and Lagos. The surgeons are delivering better outcomes and the results (published) are as good as 90-95%. In effect, up to 95 out of 100 patients coming for spine surgery have a good outcome and return home safely.
Of course, we cannot ever boast of 100% good outcome as we are not the Almighty God! There will always be some complications and even deaths in hospitals. However, there has been so much improvements that death and disability are now few and far between.
We recently reported on 110 patients operated in Abuja over an 18 month period. Of the 110 patients 2 died (elderly gentlemen with many medical problems) and 3 had repeat operations to correct some minor problems such as a misplaced screw and poor wound healing. So, overall, 105 of 110 patients who underwent various surgeries ranging from minor to complex-major operations did well.

Trust us
So the sky is the limit. But first we must counter the myths and misconceptions. It is vitally important for Nigerians to trust the spine surgeons in Nigeria for assistance. We have improved significantly and are improving still. We will continue to deliver better outcomes as we get more patients, perfect the procedures and gain more experience. We will be able to help more people and the cost of the operations will reduce even more. Currently, the operations are way cheaper than going abroad but could be cheaper still.
If you give us a chance to help you!


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