title: Surgical Treatment of Degenerative Lumbar Spine Disease in Rural Sub-Saharan Africa: A Retrospective Study of 450 Cases and Its Future Implications.
abstract: BACKGROUND
  Treatment for lumbar disc disease and spinal stenosis is the most common reason patients seek neurosurgical consultation in rural sub-Saharan Africa. Yet the misperception remains that lacking access to magnetic resonance imaging/computed tomography and a "spine surgeon," neither a definitive diagnosis can be made nor corrective treatment instituted. To combat such therapeutic nihilism, the author has supervised the on-site training of general surgeons in rural Kenya for the past 15 years with the intent of making spine surgery available for patients in outlying provincial areas.
  
  
  METHODS
  Using a simplified, cost-effective approach for both diagnosis (myelography) and treatment (hemilaminectomy/foraminotomy for radiculopathies; decompressive laminectomy for neurogenic claudication), this retrospective study of 450 patients was undertaken to 1) determine the efficacy of such an approach, and 2) the general surgeon's role in it.
  
  
  RESULTS
  Whether performed by the instructor alone (326 cases) or by the trainee under supervision (124), 92% of patients were satisfied with their surgical results. Equally noteworthy, perioperative morbidity (less than 2%) was essentially the same within the 2 groups.
  
  
  CONCLUSIONS
  Assuming experienced spine surgeons are willing to involve themselves in such hands-on training, the results of this study affirm that general surgeons can diagnose efficiently and then treat safely such degenerative spine conditions-thereby addressing this most prevalent of disease processes that has huge socioeconomic implications for rural sub-Saharan Africans.
authors.affiliation: Department of Surgery/Neurosurgery Tenwek Hospital, Kenya Pan African Academy of Christian Surgeons, Bomet, Kenya. Electronic address: bertandvickipark@sbcglobal.net.
authors.forename: Bert E
authors.initials: BE
authors.lastname: Park
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D005500:Follow-Up Studies; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000453:epidemiology / Q000601:surgery; D007796:Laminectomy; D008159:Lumbar Vertebrae; D009422:Nervous System Diseases / Q000209:etiology; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000191:economics / Q000379:methods; D061214:Patient Safety; D011128:Polyradiculopathy / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D011843:Radiculopathy / Q000601:surgery; D012189:Retrospective Studies; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000601:surgery
keywords: Clinical presentations of lumbar DJD; Decompressive laminectomy; Hemilaminectomy/foraminotomy; Lumbar myelography; Lumbar radiculopathy; Neurogenic claudication; Spinal stenosis