Early results of two methods of posterior spinal stabilization in Nigerians

Abstract

Background: In this study, early outcomes of the spinous process wiring with vertical strut (SPWVS) were compared with that of standard pedicle screw and rod (PSR) in our patients.
Materials and Methods: We obtained patients' bio‑data, diagnosis, investigations, cost of implant, operative circumstances, complications, and outcomes from clinical documentation. Outcome measures, including postoperative infection and persistent/recurrent instabilities, implant related problems, operative blood loss and time and cost, were compared in the two groups of patients.
Results: Forty one (M:F‑0.9:1) patients had PSR and 35 (M:F‑2.2:1) had SPWVS. There was no difference in the occurrence of post‑operative instability (P = 0.630), surgical site infection (P ≥ 0.416), neurological deficits (P ≥ 0.461) and implant related complications (P ≥ 0.461) in the two groups of patients. Cost of implant in the PSR group range from N138,000 (for 2 level fusion) (1USD = N159) to N246,000 (for 4 level fusion) with an average of N192,000 (Standard deviation [SD] N44,090.81) depending on the number of level fused while the cost of implant for SPWVS was N8,000 irrespective of the number of level of fusion being carried out (P = 0.000). Mean estimated blood loss intra‑operatively was higher for PSR (761.33 [SD 396.24] ml) than SPWVS (524.58 [SD 504.70] ml) (P = 0.005). Mean operation time was 397.17 (SD 122.183) min and 249.44 (SD 130.31) min PSR and SPWVS (P = 0.000).
Conclusion: SPWVS appears to be a good alternative to PSR, especially in our resource limited environment, in view of similar post‑operative infection rate, implant complication, stability and post‑operative neurological  deterioration as well as shorter operation time, less estimated blood loss and much cheaper cost of implant in the former.

Key words: Fusion, outcome, pedicle screws, spinal wiring