Introducing Endoscopic Spine Surgery in Tanzania: Implementation Strategy and Early Clinical Outcomes.

Abstract

Study DesignProspective observational pilot study.ObjectivesIntroducing endoscopic spine surgery in low- and middle-income countries (LMICs) poses logistical and clinical challenges, yet offers potential patient benefits. This study describes the implementation of a pilot endoscopic spine surgery program in Tanzania and reports early outcomes from the first patient cohort.MethodsWeill Cornell Medicine and the University of California, Irvine facilitated the introduction of endoscopic spine surgery techniques in Tanzania through theoretical and hands-on training, equipment donations, and live surgical mentorship. Fourteen patients with lumbar pathology refractory to conservative treatment underwent endoscopic microdiscectomy and/or decompression. Outcomes were assessed using the Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) for back and leg pain, measured preoperatively and postoperatively up to 3 months. All fourteen patients (100%) completed the 3-month assessment.ResultsA structured 5-day program integrating didactic instruction, simulation-based training, and supervised live surgeries successfully introduced spine endoscopy in Tanzania. Fourteen patients underwent endoscopic lumbar decompression (FESS n = 8; UBE n = 6). At short-term follow-up, marked early reductions were observed in back-pain VAS (<i>P</i> < 0.001, Kendall's W = 0.53), leg-pain VAS (<i>P</i> < 0.001, W = 0.59), and ODI (<i>P</i> < 0.001, W = 0.79). All preoperative-versus-postoperative pairwise comparisons survived Benjamini-Hochberg false-discovery-rate adjustment (q = 0.05). These results reflect feasibility and early safety only and should not be interpreted as evidence of sustained benefit or comparative effectiveness.ConclusionThis pilot study demonstrates the successful implementation of endoscopic spine surgery in an LMIC setting through structured international collaboration. The clinical outcomes reported are short-term and observed under selected pilot conditions; larger studies with longer follow-up are needed to evaluate durability, comparative effectiveness, and external validity.