Can it be done here in Nigeria?
I get asked the same question and expression of the same fears from patients and relatives following an offer of spine surgery. Many people are scared and understandably so. Spine surgery has a bad rep in Nigeria because people have been maimed or killed. But, this was largely in the distant past!
In the past, many of the operators did not have the training or the equipment and many simply dabbled: trying to help and end up making a bad situation worse. Even now, we still have a few doctors operating: who should actually be thrown under the bus. But, we do not have a robust system in place yet to flush out the charlatans. Regardless, injuries and deaths will still occur, but usually through extraordinary situations. Deaths also occur even in advanced countries!
Sadly, spine surgery is on the cards for many people with a bad neck, a bad back or following spinal injury in road traffic accidents. Some people need surgery, of course, because of a tumour. However, the majority of patients are in the age range 40 to 60 years who have a degenerative spine disease.
What is degenerative spine disease?
This is simply arthritis or wear and tear of the joints and bones in the body. It is a consequence of old age and will likely come to us all; if we live long enough. It starts as soon as we stop growing, which for most people is about the age of 20 years. From that time, we sadly start to fall apart. Arthritis is part of that falling apart, as programmed by the Almighty.
Spinal degenerative disease or spondylosis can happen in the neck or the back. It can happen to a young or older person. It is however more common in those over 60 years of age. It can be made worse by heavy body weight, obesity, sitting for long periods, hard labour, trauma, sports and smoking. Smoking is truly bad for your bones.
Here is an example:
Alhaji Kabiru recently turned 50. It did seem that his birthday was accompanied by sudden ill health. The pain in his neck intensified overnight and was associated with pains and tingling sensations shooting down his arms. He dropped his mobile phone on several occasions without realising it! He has cervical spondylosis or arthritis in the neck.
The typical symptoms
In many patients, it causes neck pains, arm pains and perhaps difficulty writing. Usually, it affects a single nerve but if it is affecting the spinal cord, it can lead to paralysis and severe disability. In many such situations the patient has weakness of the hands and legs, numbness of the hands and feet, poor control of urine and difficulty in walking. It can be so bad that walking is impossible, and passing urine and faeces becomes uncontrollable.
Here is another:
Madam Veronica complained of severe right leg pain. The pain shoots down the leg from the hip to the toes. Walking was difficult and she could not stand for longer than 5 minutes. So she has to sit as soon as the pain starts. However, she is usually unable to find a totally comfortable position and often sits on the right cheek of her buttocks which helps a little. There is numbness in the leg and often her slippers falls off without her realising it. She has lumbar spondylosis or arthritis in the lower back.
The typical symptoms
In many patients, it causes back pains, leg pains and perhaps difficulty walking. Usually, it affects a single nerve but if it is affecting many nerves it can cause symptoms in both legs. Some people have pain in the legs, difficulty standing for long, difficulty walking and reduction in the distance they can walk.
Diagnosis and treatment
X-rays and an MRI scan are the usual investigations required for anyone complaining as described above. The usual first people to visit are the local general practitioners who should refer patients specifically to a spine specialist. However, since everyone calls themselves a specialist, it is difficult for even doctors to sort out the grain from the chaff.
Surgery for spine diseases
Neurosurgeons and orthopaedic spine specialists are trained to recognize, diagnose and treat spine diseases like cervical spondylosis. In this respect, the treatment for moderate or severe cervical myelopathy is surgical. Surgical treatment may be required for severe pains or if there is evidence of damage to the nerves or spinal cord.
Surgery removes the new bone formed (hard like concrete!) from pressing on the nerves and spinal cord. This then allows information from the brain to pass through to the muscles. So, the muscles wake up to their responsibilities and the work of movement.
Reversing medical tourism
Many people have gone abroad for their spine treatment. But with the current economic situation in the country, many who would ordinarily have travelled out will stay to have it done here.
It is often cheaper and a much better experience than a long journey abroad. Take for instance the cost of a simple lumbar spine operation: Roughly N1, 000, 000 here in Nigeria and as much as N5, 000, 000 in UK or N10, 000, 000 America. Perhaps about N2, 500, 000 in India and Egypt! Please add the cost of travel to the bill and of course, feeding plus hotel accommodation for two people. Complex operations cost a lot more, of course.
Also, the follow up care is more palatable than travelling back and forth at huge cost. Many who have travelled abroad for spine treatment cannot afford to return there in case of any concerns. It’s simply too much money to pay for a 5 minutes follow up. So, of course, you should stay home and be treated here.
The operations can be performed effectively and safely in Nigeria. Therefore, I would like to encourage you to be treated here. We have formed the special purpose vehicle ‘Spine Fixed In Abuja’ to promote spine treatment in Abuja. We have also formed the West African Spine and Scoliosis Society to help with the education and training of young surgeons in the best ways to treat spine diseases. It will allow us to continue to develop and ensure we keep getting better outcomes for all.
If we say we can do it, do it with a Nigerian doctor!
NB: And do not worry, we will soon have programs in place to ensure that those who perform spine operations have specific certification. They would have been vetted and certified as capable and fully trained in spine surgery.