Reporting the first minimally invasive spine surgery series in Nigeria: a descriptive single-center retrospective cohort study

Minimally invasive spine surgery (MISS) has gained traction since its introduction into the spine surgery armamentarium, resulting in better outcomes than the traditional open approaches. It was only recently introduced in Nigeria, where it is rarely performed. In a bid to improve access to state-of-the-art neurosurgical services in his home country, the senior author, having practiced MISS in the United States, started performing it in Nigeria in 2017. We aim to describe our MISS experience in Nigeria, a lower-middle-income country (LMIC) with high poverty indices, and report the first series of these surgeries in the country. This is a descriptive single-center retrospective cohort study performed through a review of our database of patients who had MISS for degenerative disc disease involving the thoracic, lumbar, and lumbosacral spine regions from April 2017 to May 2022. Demographic, perioperative parameter (surgery duration [SDn], estimated blood loss [EBL], length of hospital stay [LOS]), perioperative surgical site complication, and patient-reported outcome (Numeric Rating Scale [NRS] and Oswestry Disability Index [ODI]) data were retrieved and analyzed. Minimal important differences (MID) in the patient-reported outcomes (PROs) were defined as improvements of a two-point change for NRS and a 5.9-20-point difference for ODI. The same lead surgeon performed the procedures with similar operative techniques and perioperative management. The data of the 143 patients were not normally distributed. The median age was 62 years, and males comprised 55.9%. Fifty-one percent of the patients had minimally invasive (MIS) laminectomy; 45.5% and 3.5% had MIS-transforaminal lumbar interbody fusion (TLIF) and MIS-microdiscectomy, respectively. Most (73.4%) were in the lumbar spine, 25.2% involved the lumbosacral junction, and 1.4% were in the thoracic spine. Median SDn, EBL, and LOS were 112 mins, 50 mL, and 3 days, respectively. The perioperative surgical site complication rate was 4.9%. The PROs showed statistical improvement and MID between baseline and one-year follow-up. This study's perioperative parameters and surgical site complication rates are comparable to those obtained from previous work on MIS lumbar decompression (laminectomy and microdiscectomy) and MIS-TLIF in higher-income countries. Additionally, the patients' improvements in the PROs were comparable to findings in spine surgery research in higher-income countries. Our efforts to introduce MISS as part of our practice in Nigeria are informed by the need for deploying, developing, and maintaining beneficial cutting-edge care in LMICs where the capacity exists, while not neglecting the 'stock' procedures. MISS is available in Nigeria, and it is characterized in our practice by satisfactory perioperative parameters, perioperative surgical site complication rates, and PROs that are comparable with those obtained from MISS and other spine surgeries performed in countries with high incomes, where MISS is rife.