Tubular spinal micro decompression surgery with integrated 2D camera visualization: initial experience and feasibility in Tanzania.

Overview

abstract

BACKGROUND: The 2D camera visualization system is a novel, video device that provides high-definition, magnified views of the surgical field through a tubular retractor system. This study reports the initial experience using the novel 2D camera-based visualization system for tubular spinal micro decompression surgery in Tanzania. METHODS: This prospective cohort study, conducted between 2022 and 2024, included 17 patients with one- to two-level lumbar spinal stenosis or disc herniation presenting with radiculopathy and/or claudication who had not responded to conservative management. Data on patient demographics, surgical details, complications, hospital stay, and Numeric Rating Scale (NRS) scores over a six-month follow-up period were collected and analyzed descriptively. RESULTS: Among the 17 patients in the study, male were 10 (59%), aged 61 years (IQR: 45-65), presented with L4-L5 spinal stenosis 65% (11/17). The mean preoperative NRS score was 8. The operative time was 150 min (SD: 33), Durotomy occurred in five patients (29%), four of which took place during the first year of implementation. The median hospital stay was three days (IQR: 2-4). One patient (6%) developed Surgical site infection (SSI). Overall, significant improvement in NRS scores was sustained throughout the six-month follow-up period. No intraoperative nerve injuries or neurological deficits were observed. CONCLUSION: The integration of a tubular-mounted digital camera visualization system is a feasible adjunct for Minimally Invasive Spine Surgery (MISS) in Tanzania, offering distinct advantages in ergonomics, training, and cost-effectiveness compared with operative microscopy. Although the initial learning curve was associated with a higher incidence of durotomy, outcomes improved with experience.