• Mark C Chikani, Mathew Mesi, Okwuoma Okwunodulu, Wilfred Mezue, Samuel Ohaegbulam, Chika Ndubuisi, Linda Iroegbu, and Sunday Nkwerem.
• Neurosurgery Unit, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria; Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria. Electronic address: markochikani@yahoo.com.
• World Neurosurg. 2019 Oct 1; 130: e815-e821.

BackgroundSpine conditions are common and the surgery is evolving even in developed economies. This study aims to review the changing trends and challenges of spine surgery, particularly from a low-income country.MethodsThis is a retrospective study of patients who were surgically treated for spine conditions in Enugu, Nigeria. Patient records from 2006 to 2016 were reviewed. Relevant clinical information was extracted from the operation theater logbooks and patient case files.ResultsA total of 463 spine surgical procedures were carried out on the same number of patients. The number of treated patients has been on the increase and shows a male predominance. Pediatric spine cases accounted for 1.5%, adult/middle aged patients accounted for 77.8%. Degenerative conditions, trauma, and neoplasms were the most frequent indications for operation, accounting for 52.3%, 30.5%, and 11.4%, respectively. The most commonly operated region was cervical and lumbar regions among male (49.3%) and female (51.8%) patients, respectively. Spine fixation was required in 137 patients (29.6%). A paradigm shift from trauma to degenerative conditions among patients was noted after 2010. Prior to 2009, spine wiring techniques were the most common spine stabilizing method, but from 2011 to 2013 anterior cervical discectomy and anterior cervical discectomy and fusion predominated, and thereafter pedicle screws predominated. Cost implications, lack of trained personnel, and lack of and basic equipment pose significant challenges to spine care.ConclusionsThe trend in spinal surgery has improved rapidly and consistently in Nigeria over the 10 years of the study and is related to increasing expertise, more available facilities, and implant availability.Copyright © 2019. Published by Elsevier Inc.

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