The Role of MI Spine Surgery in Global Health: A Development Critique

  • Carlyn R. Rodgers
  • W. B. RodgersEmail author


The rapid evolution of less disruptive spinal surgery during the last two decades has been driven by revolutionary technical advances, demonstrable improvements in outcome, and reductions in complications compared with open procedures. The benefits to patients around the world and in marginalized populations have been documented. These new technologies and techniques can be resource-intensive and are typically beyond the budgets of the ministries of health of nations in the Global South. However, the benefits to patients, particularly lower infection rates and more rapid return to activities of daily living, have the capacity to provide more value and economic advantages to these underserved populations.

The patient benefits offered by less disruptive spinal surgery could be translated to an increasing number of patients around the world in accordance with the principles of the Global Surgery 2030 initiative. To date, many of the applications of these novel procedures have been offered through industrial foundations or nongovernmental organizations, either as donations of equipment or as sponsored, episodic “missions” comprised of surgical teams from the Global North. To our knowledge, this chapter represents the first attempt in the spinal surgery literature to discuss the possibilities and pitfalls of these well-intentioned interventions through a biosocial approach and to apply the established best practice criteria from the field of Global Development to the specific case of MI Spinal surgery in the Global South.


Global health Global North/Global South Development Best practice Surgery Critique 


  1. 1.
    Meara JG, Leather AJM, Hagander L, Alkire BC, Nivaldo A, Ameh EA, et al. Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386:569.–6736(15)60160-X.CrossRefGoogle Scholar
  2. 2.
    McAfee PC, Phillips FM, Andersson G, Busenenadran G, Kim CW, Lauryssen C, et al. Minimally invasive Spine surgery. Spine. 2010;35(26 Suppl):S271–3.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Phillips FM, Cheng I, Rampersaud YR, Akbarnia B, Pimenta L, Rodgers WB, et al. Breaking through the “glass ceiling” of minimally invasive spine surgery. Spine. 2016;41(8Suppl):S39–43.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Kim, JY. Opening address to the inaugural “The Lancet Commission on Global Surgery” meeting. The World Bank. Jan 17, 2014. Boston, MA. Accessed 27 June 2017.
  5. 5.
    Barrero LH, Hsu YH, Terwedow H, et al. Prevalence and physical determinants of low back pain in a rural Chinese population. Spine. 2006;31:2728–34.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Louw QA, Morris LD, Grimmer-Somers K. The prevalence of low back pain in Africa: a systematic review. BMC Musculoskelet Disord. 2007;8:105–9.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Naidoo S. Women’s occupational health working in small-scale agriculture in South Africa. (2011 Utrecht University Repository) (Dissertation), Utrecht, Netherlands.Google Scholar
  8. 8.
    Omokhodion FO. Low back pain in a rural community in South West Nigeria. West Afr J Med. 2002;21:87–90.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Omokhodion FO. Low back pain in an urban population in Southwest Nigeria. Trop Dr. 2004;34:17–20.CrossRefGoogle Scholar
  10. 10.
    Hoy D, Bain C, Williams G, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64:2028–37.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73:968–74.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Hoy D, March L, Brooks P, et al. Measuring the global burden of low back pain. Best Pract Res Clin Rheumatol. 2010;24:155–65.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine. 2006;31:2724–7.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Volinn E. The epidemiology of low back pain in the rest of the world. Spine. 1997;22:1798.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Volinn E. The epidemiology of low back pain in the rest of the world. A review of surveys in low- and middle-income countries. Spine. 1997;22:1747–54.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Bejia I, Younes M, Jamila HB, et al. Prevalence and factors associated to low back pain among hospital staff. Joint Bone Spine. 2005;72:254–9.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Eriksen W, Natvig B, Bruusgaard D. Smoking, heavy physical work and low back pain: a four-year prospective study. Occup Med (Lond). 1999;49:155–60.CrossRefGoogle Scholar
  18. 18.
    Ezzati M, Lopez AD, Rodgers A, et al. Selected major risk factors and global and regional burden of disease. Lancet. 2002;360:1347–60.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Galukande M, Muwazi S, Mugisa DB. Aetiology of low back pain in Mulago Hospital, Uganda. Afr Health Sci. 2005;5:164–7.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Gilgil E, Kacar C, Butun B, et al. Prevalence of low back pain in a developing urban setting. Spine. 2005;30:1093–8.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Loeser JD, Volinn E. Epidemiology of low back pain. Neurosurg Clin N Am. 1991;2:713–8.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Lopez AD, Mathers CD, Ezzati M, et al. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367:1747–57.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Omokhodion FO, Umar US, Ogunnowo BE. Prevalence of low back pain among staff in a rural hospital in Nigeria. Occup Med (Lond). 2000;50:107–10.CrossRefGoogle Scholar
  24. 24.
    van Vuuren BJ, Becker PJ, van Heerden HJ, et al. Lower back problems and occupational risk factors in a South African steel industry. Am J Ind Med. 2005;47:451–7.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81:646–56.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Library of Congress—Federal Research Division. Country Profile: Kenya. 1–6-2007. Accessed 24 June 2017.
  27. 27.
    WHO Scientific Group on the Burden of Musculoskeletal Conditions of the Start of the New Millenium. The burden of musculoskeletal conditions at the start of the new milleniunm. World Health Organ Tech Rep Ser. 2003;919:1–218.Google Scholar
  28. 28.
    World Health Organization (WHO). Global Health Observatory (GHO). 2012. Accessed 8 Oct 2014.Google Scholar
  29. 29.
    Mijiyawa M, Oniankitan O, Kolani B, et al. Low back pain in hospital outpatients in Lome (Togo). Joint Bone Spine. 2000;67:533–8.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Oniankitan O, Magnan A, Fianyo E, et al. Low back pain with radiculopathy in hospital outpatients in Lome (Togo). Joint Bone Spine. 2008;75:235–6.PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2197–223.CrossRefGoogle Scholar
  32. 32.
    Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2163–96.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Murray CJ, et al. The state of US health, 1990–2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310:591–608.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Hoy DG, Smith E, Cross M, et al. The global burden of musculoskeletal conditions for 2010: an overview of methods. Ann Rheum Dis. 2014;73:982–9.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Desai V, Potter RB, editors. Doing development research. London: Sage Publications; 2006.Google Scholar
  36. 36.
    Hanna B, Kleinman A. Unpacking global health: theory and critique. In: Farmer P, Kim JY, Kleinman A, Basilico M, editors. Reimaging global health: an introduction. Berkley/Los Angeles: University of California Press; 2013. p. 15–32.Google Scholar
  37. 37.
    Katz JN, Losina E. Cost-effectiveness of spine surgery: the jury is out. Ann Intern Med. 2008;149:901–3.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Natvig B, Eriksen W, Bruusgaard D. Low back pain as a predictor of long-term work disability. Scand J Public Health. 2002;30:288–92.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Boswell MV, Shah V, Everett CR, Sehgal N, Mckenzie-Brown AM, Abdi S, et al. Interventional techniques in the management of Chronic Spinal pain: evidence-based practice guidelines. Pain Physician. 2005;8:1–47.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Welling DR, Ryan JM, Burris DG, Rich NM. Seven sins of humanitarian medicine. World J Surg. 2010;34:466–70.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Farmer P, Kleinman A, Kim J, Basilico M. Reimagining global health: an introduction. California: University of California Press; 2013.Google Scholar
  42. 42.
    Mussa AH, Pfeiff er J, Gloyd SS, Sherr K. Vertical funding, non-governmental organizations, and health system strengthening: perspectives of public sector health workers in Mozambique. Hum Resour Health. 2013;11:26.–4491–11–26.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Perry L, Malkin R. Effectiveness of medical equipment donations to improve health systems: how much medical equipment is broken in the developing world? Med Biol Eng Comput. 2011;49:719–22.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    WHO. Guidelines for health care equipment donations. 2000. Accessed 27 June 2017.
  45. 45.
    Rodgers WB, Gerber EJ, Rodgers JA. Lumbar fusion in octogenarians: the promise of minimally invasive surgery. Spine. 2010;35(26Suppl):S355–60.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Rodgers WB, Cox CS, Gerber EJ. Early complications of eXtreme lateral interbody fusion (XLIF) in the obese. J Spinal Disord Tech. 2010;23:393–7.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Smith WD, Dakwar E, Le TV, Christian G, Serrano S, Uribe JS. Minimally invasive surgery for traumatic spinal pathologies: a mini-open lateral approach in the thoracic and lumbar spine. Spine. 2010;35(26Suppl):S338–46.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Dakwar E, Cardona RF, Smith DA, Uribe JS. Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis. Neurosurg Focus. 2010;28:E8.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Isaacs RE, Hyde J, Goodrich JA, Rodgers WB, Phillips FM. A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: perioperative outcomes and complications. Spine. 2010;35:S322–30.PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    Berjano P, Cecchinato R, Sinigaglia A, et al. Anterior column realignment from a lateral approach for the treatment of severe sagittal imbalance: a retrospective radiographic study. Eur Spine J. 2015;24(3 Suppl):433–8.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Rodgers WB, Gerber EJ, Patterson J. Intraoperative and early postoperative complications in extreme lateral interbody fusion: an analysis of 600 cases. Spine. 2011;36:26–32.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Lucio JC, VanConia RB, DeLuzio KJ, Lehmen JA, Rodgers JA, Rodgers WB. Economics of less invasive spinal surgery: an analysis of hospital cost differences between open and minimally invasive instrumented spinal fusion procedures during the perioperative period. Risk Manag Healthc Policy. 2012;5:65–74.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Rampersaud YR, Gray R, Lewis SJ, et al. Cost-utility analysis of posterior minimally invasive fusion compared with conventional open fusion for lumbar spondylolisthesis. SAS J. 2011;5:29–35.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Centre of Latin American Studies, University of CambridgeCambridgeUK
  2. 2.University of QuadraHeriot BayCanada

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