Clinical and safety outcomes of decompressive surgery for patients with degenerative lumbar spine disease in the Gaza Strip: a prosective study

Abstract

Objectives

A significant number of patients with degenerative lumbar spine disease (DSD) require decompressive surgery. Disparities in surgical care exist between different countries and regions. This study reports on the clinical and safety outcomes of lumbar decompressive surgery performed in the Gaza Strip, a poor and underserved area with a fragile healthcare system.

Methods

Patients with DSD were prospectively followed up after undergoing lumbar decompressive surgery at two major governmental hospitals in the Gaza Strip between October 2019 and March 2020. Outcomes were assessed using the Core Outcome Measure Index (COMI-back) and the Oswestry Disability Index (ODI), measured both before and three months after surgery. Surgical complication rates were also evaluated. A paired t-test was performed to explore the significance of differences in the mean pre- and postoperative scores for each COMI variable and the ODI item.

Results

Sixty-six patients were included, consisting of 41 (62.1 %) males and 25 (37.9 %) females, with a mean age of 61.02 ± 11.4 years. The total COMI-back score decreased from 27.3 ± 6 to 10.3 ± 10 postoperatively (p < 0.0001). A decrease of 15.15 points was also noted between the mean ODI scores before and after surgery (p < 0.0001). Similar significant decreases were observed across all COMI-back and ODI items. The three-month global outcome indicated that the operation benefited 47 patients (71.2 %). Likewise, 39 (59 %) and 19 (28.7 %) reported being “highly satisfied” or “satisfied” with the overall state of their back/leg symptoms, respectively. Eight (12.1 %) patients experienced a postoperative complication: six (9.5 %) had wound infections, one (1.5 %) sustained a dural tear, one (1.5 %) experienced a CSF leak, and one (1.5 %) needed reoperation. The mean hospital stay was 2 days ± 1.3 days.

Conclusion

The study shows a significant improvement across all outcome parameters from baseline to the three-month postoperative follow-up, with rates of surgical complications and hospital stays comparable to global averages.