Revision Surgery for Degenerative Spine Disease in Low Income Countries: A Growing Challenge in Resource Limited Neurosurgical Settings
Keywords:
Revision spine surgery, degenerative spine disease, low-income countries, neurosurgery, functional outcomes, ODI, VASAbstract
Background: Surgery for degenerative spinal illnesses is revision surgery is common nowadays, but is also very difficult in low-income countries due to limited imaging, implants, and post-operative infrastructure. Patients frequently show up late, have complicated pathologies, and have unsuccessfully undergone prior first-stage surgeries, thereby greatly complicating the revision surgeries.
Objectives: To evaluate the clinical, radiological, and functional outcomes of revision spine surgery in a resource-limited neurosurgical setting and to compare recovery patterns between cervical and lumbar revision cases.
Methods: An observational study spanning one year was performed on 82 patients receiving revision surgeries due to degenerative diseases of the spine. The demographic details, information on the operative variables, complications, and the VAS and ODI scores recorded preoperatively and postoperatively were documented and then compared between the cervical (Group A) and lumbar (Group B) cohorts.
Results: Following the surgical procedures, there were no major differences in length of surgery, complications, functioning outcomes, or degree of operative disability, yet, both groups of participants showed strong decreases in the disability and pain operative scores. In case of lumbar revisions, there were higher percentages of operating recurrent disc herniation, and with the other named reasons there were pseudarthrosis and adjacent segment operated disease in both of the groups.
Conclusion: Revision spine surgery provides meaningful improvements in pain and functional recovery even in low-resource environments. With careful case selection and standardized perioperative practices, outcomes comparable to higher-income regions can be achieved despite limited infrastructure..
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[1] Weiss, H.K., et al., A systematic review of neurosurgical care in low-income countries. 2020. 5: p. 100068.
[2] Zileli, M., et al., The Role of Neurosurgery in Global Spine Health, in Neurosurgery and Global Health. 2022, Springer. p. 87-106.
[3] Philipp, L.R., et al., Achieving value in spine surgery: 10 major cost contributors. 2021. 11(1_suppl): p. 14S-22S.
[4] Sharif, S.Y., et al., History of spinal neurosurgery and spine societies. 2020.
[5] Du, R.Y., et al., Pediatric neurosurgery in East Africa: an education and needs-based survey. 2020. 141: p. e374-e382.
[6] Fiani, B., et al., Impact of robot-assisted spine surgery on health care quality and neurosurgical economics: a systemic review. 2020. 43(1): p. 17-25.
[7] Safaee, M.M., C.P. Ames, and J.S.J.N. Smith, Epidemiology and socioeconomic trends in adult spinal deformity care. 2020. 87(1): p. 25-32.
[8] Karekezi, C., et al., The impact of African-trained neurosurgeons on sub-Saharan Africa. 2020. 48(3): p. E4.
[9] Neifert, S.N., et al., Predicting trends in cervical spinal surgery in the United States from 2020 to 2040. 2020. 141: p. e175-e181.
[10] Wittayanakorn, N., et al., Impact of COVID-19 on neurosurgical training in Southeast Asia. 2020. 144: p. e164-e177.
[11] Ahmad, A.A.A. and A. Agarwal, Early onset scoliosis: guidelines for management in resource-limited settings. 2021: CRC Press.
[12] Kim, H.S., P.H. Wu, and I.-T.J.W.N. Jang, Current and future of endoscopic spine surgery: what are the common procedures we have now and what lies ahead? 2020. 140: p. 642-653.
[13] Deora, H., et al., Management of neurosurgical cases in a tertiary care referral hospital during the COVID-19 pandemic: lessons from a middle-income country. 2021. 148: p. e197-e208.
[14] Al-Saadi, T., et al., Geriatric neurosurgery in high-income developing countries: A Sultanate of Oman experience. 2022. 3(4): p. 264-272.
[15] Mallow, G.M., et al., Intelligence-based spine care model: a new era of research and clinical decision-making. 2021, SAGE Publications Sage CA: Los Angeles, CA. p. 135-145.
[16] Ferraris, K.P., et al., Financial risk protection for neurosurgical care in Indonesia and the Philippines: a primer on health financing for the global neurosurgeon. 2021. 8: p. 690851.
[17] Budohoski, K.P., et al., From the Annals of Weill Cornell Neurological Surgery.
[18] Nurmukhametov, R., et al., Transforaminal fusion using physiologically integrated titanium cages with a novel design in patients with degenerative spinal disorders: a pilot study. 2022. 3(3): p. 175-184.
[19] Yeo, C.J., et al., Ethical perspectives on treatment options with spinal muscular atrophy patients. 2022. 91(3): p. 305-316.
[20] Bowen, I., et al., Infrastructural limitations in establishing neurosurgical specialty services in Liberia. 2022. 14(9)..
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