Spine surgery is an individual thing. Operations are designed specifically for each patient and what Joe had may not be suitable for Adamu. Operations are often designed to achieve one of two results: remove pain or to free the nerve from compression. The pain may be coming because of instability of the bones or pressure on the nerve.
So, operations may be designed to free the nerves or to fix the bone or both. More often than not, the surgery will involve cutting of the skin to get to the bones or nerves. You can do that through a tiny hole (minimally invasive: using a microscope or by using special tubes and cameras) or through a hole wide enough for a surgeon and his assistant to climb into (conventional open surgery). What do you care, so long as the job is done and you are free of pain!
However, lets explain the issues related to the type of operation we do for spine diseases.
Conventional Open Surgery
Conventional operations on the spine entails opening the skin widely and dissecting the muscles to get to the bone and nerves to perform the operation. For example, a patient complaining of back pain and leg pains may require surgery that will remove pressure on the nerves and then fixation as shown in the picture above.
The operation is usually performed under general anesthesia and could last for upwards of 4 hours. The open operation can be complicated by bleeding and pain from the muscle dissection. This interferes with recovery with some patients requiring blood transfusions and massive amounts of pain killers. There is sometimes difficulty with wound healing and scar tissue formation.
So, these issues led to the development of minimally invasive spine surgery.
Minimally Invasive Spine Surgery
This technology allows spine surgery to meet its objectives through minimally invasive techniques that offer some benefits over traditional open back surgery. These benefits also include: minimal scarring and better cosmetic results. One must not forget reduced risk of infection due to small surgical incisions.
The idea is to be able to perform the same operation through small skin incisions, limited muscle dissection leading to almost no significant blood loss and less post-operative pain. These may then lead to better recovery and even at times earlier discharge home.
Endoscopic surgery
Some operations are also performed through small special tubes with cameras called endoscopes. Of course, a small number of patients have had laser spine surgery for back pain.
This is however not suitable for everyone and careful selection is very important.
Word of caution
Some patients come into the clinic asking specifically for a type of operation, they may have heard or read about on the internet. Minimally invasive spine surgery or laser spine surgery does not automatically mean no risk. There are still risks associated with such operations both in the short term and longer term. Also, note that all operations are designed to solve the problems presented with at that specific point in time.
However, arthritis (cervical and lumbar spondylosis) is a progressive disease. We cannot stop the ageing process.
Case report
We recently admitted a middle-aged woman of 58 years. She presented with a history of severe low back pain and pain in the right leg associated with numbness in the toes. She described difficulty walking long distances. The pain started in 2010 but worsened in 2014 and has been progressing in severity since then.
We performed x-rays and an MRI scan of her spine in the lower back which showed ‘kissing vertebra’. This means that the shock absorber between two bones in her back had worn out completely hence the bones were rubbing together causing severe back pain.
She was examined and felt suitable for surgical intervention. We opted for a minimally invasive procedure for her and the operation was performed uneventfully. She recovered very well and was in hospital for only 5 days before discharge home.
In Abuja
Patients with spine disease can be operated safely and successfully in Nigeria. Specifically, patients with lumbar and cervical spondylosis can be reassured that such operations are safe in Abuja. Patients should no longer have to travel abroad on medical tourism to manage these conditions. They can be treated successfully with comparable outcomes in Abuja. The operations are also at times significantly cheaper than the cost of a plane ticket. Nigerians also need to know that the odds of getting a successful surgery are great.
The choices of operation as discussed above are all available except laser spine surgery. We can perform conventional open operations or the minimally invasive spine surgery for patients who deserve either. We help the patient choose the best operation to deliver the best outcomes.
And yes, patients are getting better outcomes.
