Revision Surgery For Degenerative Spine Disease in Resource-Limited Neurosurgical Settings of A Low – Income Country: A Growing Challenge

Abstract

Purpose: To determine the functional outcome and perioperative complications of degenerative spine disease revision surgery in a resource-constrained neurosurgical environment.

Materials & Methods: One hundred adults (>= 18 years) who had undergone degenerative cervical/ thoracic/ lumbar spine surgery before and were undergoing revision surgery were recruited. The demographic data, comorbidities, surgical history, hospitalisation, and perioperative complications (30 days) were captured. The Oswestry Disability Index (ODI) and the visual analogue scale (VAS) were used as a functional outcome measure during preoperative and 6 months postoperative. The response to be classified as a favorable outcome was a 30 percent or greater reduction in ODI and a 2-point or greater reduction in VAS with no new permanent neurological impairment.

Results: Mean ODI changed to an improved value of 37.10 ± 9.42 (as compared to 56.49 ± 9.42), and mean VAS to a worse value of 4.79 ± 1.33 (as compared to 7.50 ± 0.94). A positive result was attained in 58 percent of patients. The adverse effects included but were not limited to dural tear (7%), wound infection (6%), new neurological deficit (4%), implant-related problems (5%), and major medical events (3%). There was no significant baseline or surgical factor that had any association with outcome.

Conclusion: Degenerative spine disease after surgery may be effectively revised to generate significant functional outcomes with satisfactory complication rates in a resource-restricted environment.

Keywords: Spinal Diseases/surgery, Reoperation, Developing Countries, Neurosurgical Procedures, Treatment Outcome.