Mrs O came to see me recently complaining of a long period of back pain. She is a 69 year old widow who travelled from Lagos for a consultation. On review she gave a history of chronic low back pain (waist pain) and bilateral leg pains. The pains were severe on standing and made walking pretty difficult.
She walks bent forward. Sitting makes the pain better and she sleeps comfortably.
Interestingly, anyone looking at her would conclude she was in great health. But, she knows better. Driving her car is entirely satisfactory until she has to get out of the car. Then, the pains start and she walks like an old woman.
She walks bent forward. Folding her hands on her back provides some relief.
Mrs O is the envy of people who see her looking splendid in her car. Many people see her and appreciate her good looks and sedate appearance behind the wheels. Unfortunately, little do they know how much she envies the people walking past her car? She envies the fact that they can walk!
She walks bent forward. A lumbar corset tightly around her waist provides scant relief.
Sadly, this problem started 5 years ago and has progressively worsened in the past 3 years. She finds it difficult in church. She has to sit to pray or make any comment in church. The church elders actually warned her against surgical intervention. They said she would either die or become paralysed should she have an operation.
However, over the past few months, life has become miserable and now she has pins and needles sensation all over the legs. She also has numbness in the legs which feel like wooden stumps instead of her legs. She feels unsteady and could fall anytime.
She would like to walk erect.
This is why she came over to see us in Abuja. Her MRI scan shows lumbar spondylosis. This is arthritis of the lower back for the uninitiated. Her bones were crumbling and pressing on her nerves causing severe back pains and the leg pains respectively.
An operation is required as suggested 3 years ago. However, now the operation is bigger and more expensive than it would have been at that time. The bones are also much worse than before and require more dramatic care.
Many people are scared stiff of spine operations in Nigeria and expressed the believe that spine operations were a 50/50 affair. Many said they have heard that patients die or are paralysed after spine surgery and so preferred conservative management.
A do and die affair!
Yet, many were actually suffering with abysmal quality of life. A patient recently asked me to speak to her daughter, a medical doctor, who also expressed the same fear. That spine surgery is 50:50. So even doctors who should know better are afraid to subject their relatives to spine surgery.
The other major concern for patients and relatives is the age of the patient. Some consider anyone above 55 as too old for spine surgery and similarly, anyone below 30, as too young.
A misconception, of course. Age has little to do with spine surgery. We can operate on any deserving person so long as there is a good reason for surgery and they are medically fit to undergo the operation.
They have to be assessed and certified fit for the operation and the type of anaesthesia that may be required. We also try to ensure that the real benefits of the operation outweighs the possible side effects inherent in the operation. Finally, we have to be sure we can provide a safe environment for the patient to have a successful procedure.
This article serves to provide current information for the general public and especially medical doctors including orthopedic surgeons and physiotherapists. Spine operations have improved in quality and we now boast of much better outcomes than before. Continuing conservative management in a patient that is visibly deteriorating should no longer be tolerated.
There are now skilled operators in many centres in Nigeria. Spine surgeons are delivering better outcomes and the results (published) are as good as 90-95%. In effect, up to 95 out of 100 patients coming for spine surgery have a good outcome and return home safely.
Of course, we cannot ever boast of 100% good outcome as we are not the Almighty God! There will always be some complications and even deaths in hospitals. However, there has been so much improvements that death and disability are now few and far between.
So the sky is the limit.
But first we must counter the myths and misconceptions. It is vitally important for Nigerians to trust the spine surgeons in Nigeria for assistance. We have improved significantly and are improving still. We will continue to deliver better outcomes as we get more patients, perfect the procedures and gain more experience. We will be able to help more people and the cost of the operations will reduce even more. Currently, the operations are way cheaper than going abroad but could be lower still.
If you give us a chance to help you, you will walk erect! Again…