Age and spine surgery in Nigeria

Dr. Biodun Ogungbo

 

Mama Catherine suffers from back and leg pains. She was finding it increasingly difficult to walk and so was becoming dependent on family members for help. A previously active and independent woman, she has become incapacitated and reduced to enforced bed rest. Her MRI scan showed she had a narrowing in her spine and could benefit from surgery. However, Mama is almost 90 years old! What should we do?

Chief Nkwocha was disabled by back pain. He walks slowly using a cane and can only take a few steps before the pain arrives. He then has to bend forward or sit down or else his legs might give way. The pain, as described, was severe, unrelenting and associated with numbness in the legs. His MRI scan showed multiple levels of narrowing in his spine due to arthritis. He would benefit from surgery. However, he is 80 years old, suffering from hypertension and diabetes. What should we do?

Mama Yunusa stopped walking in March. Her arms and legs simply stopped moving. She also complained about pain in the neck. She was effectively bedridden and had to be carried to the bathroom by her daughter. A fiercely independent woman was reduced to a helpless state and indignity. Her MRI scan showed severe pressure on her spinal cord – by arthritis. She also needs an operation. She is 80 years old. What should we do?

Arthritis in the elderly

The causes of back pain are nearly as numerous as terms used to describe the symptoms. Back pain is a primary reason people seek medical attention. Considering that almost 80% of the adult population will encounter some form of back pain, it could be said that back pain is a universal epidemic. Back pain respects no age, economic, or ethnic barriers. Everyone will likely suffer from back pain at some time in their life. More and more elderly will suffer from back pains, neck pain due to the degeneration caused by arthritis. Arthritis is one of God’s apps: a computer program embedded in our genes!

Arthritis causes wearing out of the bones and pressure on the nerves and spinal cord. This destruction of the bone causes instability which may require operation to reinforce the bones. The pressure on the nerves may require operation to free the nerves and release the pressure.

Age and spine surgery

There is real fear of spine surgery, especially in the elderly. The poor results of the past are still clouding the present and jeopardising the future. The fear is of paralysis and death as well as of becoming disabled due to weakness of an arm or leg. Because of this, many patients are not offered surgery and instead are taken to the village or to church. Many are left at home in pain until death eventually comes. Before death though, someone has to look after mama or papa, and someone may have to leave employment to stay home with them.

More importantly, what is happening in the present? How many days will mama or papa suffer in pain, helpless and hopeless? How much pain can they tolerate? How can you cope with the misery and the cries in the middle of the night?

The important issue as regards planning for surgery is a firm diagnosis, clear evaluation of the physical status of the patient, assessment of the fitness for surgery, a clear surgical plan, honest balance of the benefits and risks of surgery in the hands of the surgeon and effective post- operative support by spine-trained physiotherapists.

Surgery on the spine is safe if performed by experienced surgeons and with adequate expert support from the nurses and physiotherapists. Elderly patients suffering from arthritis of the spine should not be left in pains and misery. Something should be done when an older person starts crying in the mornings and praying for early death on dark nights.

What to do?

We evaluated Mama Catherine and offered her surgery. She tolerated the procedure well and has a new lease of life. She can stand and walk freely. She can go to and from the bathroom without support and is becoming independent daily.

Papa Nkwocha was prepared for operation after careful stabilisation of his blood pressure and blood sugar. This required a specialist physician to sort him out before, during and after surgery. He had his spine decompressed in a two-hour operation and was discharged home in great condition.

Mama Yunusa also required urgent operation on her neck to decompress the spinal cord. The operation was well tolerated and she has recovered well. She is still paralysed but showing early signs of improvement. At least, she now has a smile on her face and feels that the future is bright.

Spine fixed in Nigeria

Age is no barrier to surgery in the elderly. If it can be done safely and if the benefits outweigh the risks, then , no problem! Of course, no one can guarantee 100 per cent success but the majority will benefit and have a new future.