Lumbar spine surgery; Instrumentation; Complex cases; Management.

SUMMARY: Over 30% of the operative cases the neurosurgeons from Memphys Hospital in Enugu, Nigeria performed are spine cases. Instrumentation is more commonly used than in the past. The neurosurgeons present two complex cases of spine surgery for intefnational discussion on management that are challenges everywhere. The first is a 78 year old patient who, 7 years previously, in another country for chronic back pain and degenerative disease of the spine and with pedicle screw fusions. 3 years later the patient had a posterior cervical decompression, thoracic decompression, and revision of lumbar surgery. No other information was available. Four years following later in 2024, he presented to Memphys Hospital. with back and bilateral radicular leg pain but neurologically intact. MR and CT Imaging suggested loose screws in the lumbar region. The surgeons revised the implant, L1-L5, revised the loose screws and added a hydroxyapetite fusion. The patient was not improved after surgery. No infection was found. The international discussion of this case followed. How would you manage this case? A second case involved a patient with acute cervical spine injury, Grade II antero-listhesis at C6-7 and quadriplegic on admission and was operated 15 hours after admission and 3 days after injury. Some cervical cord swelling was seen on admission studies. At surgery he had rupture of the ALL and PLL an annulus tear, extruded disc, and antero-listhesis. He had numerous pulmonary complications after surgery and a delayed tracheostomy, 4 weeks after surgery. He was unchanged clinically. He was on a ventilator for 7 months with no improvement. How would you manage this case? What are the lessons in this case? Public Education, Early surgery, careful intubation, protection against any motion at surgery, early tracheostomy. (11/9/24-JIA)