Combining Excellence with Relevance in A Spine Outreach Program for Underserved Countries: A Report of Early and Late Complications

Purpose: (1) to evaluate the relevance of instituting a complex spine surgery program in underserved nations where facilities and expertise are lacking. (2) to evaluate the comprehensive surgical treatment programs provided, and (3) to evaluate associated complications of the programs.

Methods: Between August 1998 to November 2005, 190 patients in Ghana, West Africa (141) and Barbados, W.I. (49) underwent spine surgery for various spine disorders. There were 116 females and 74 males. Average age 67.2, years (range 1 to 77); 21 years (91 patients). Diagnostic categories include 108 scoliosis/kyphosis (13 post TB kyphosis patients), 20 degenerative disc disease, 12 spinal stenosis, 18 spondylolisthesis, 4 cervical spondylosis, and 27 other related diagnosis. There were 201 posterior spinal fusions, 4 anterior only spinal fusions, 17 same day ASF/PSF procedures, and 33 posterior decompressions. One patient required intubation following a combined anterior/posterior; a tracheotomy performed postoperatively and was later decanulated.

Results: 121 patients have greater than 2 year follow up. There were 20 complications in 18 patients (9.4%). There were two mortalities from pulmonary embolism. Late complications included pseudoarthosis in 1 patient, and 3 late infections (see tables). There were no permanent cord injuries.

Conclusions: In a safe and relatively cost effective manner, and without compromise, patients with major spinal disorders in underserved and developing countries can receive the benefits of state of the art spinal care with acceptable complication rate, compared to SRS MM data. A comprehensive review and patient selection process is an essential ingredient to achieving success in such a global outreach program.

Table 1. Complications by Type comparing Study Population to 2004 SRS Data