Complications Following Spinal Surgeries in Nigeria: A Multicenter Appraisal

Background: Spinal surgery is increasingly performed in Nigeria, yet comprehensive data on complications across multiple centres remain scarce. This multicenter study aimed to appraise the spectrum, frequency, and predictors of complications following spinal surgeries in Nigeria. Methods: A retrospective multicenter review of 638 consecutive spinal surgeries performed across four tertiary centres in Nigeria from January 2010 to December 2024 was conducted. Data on patient demographics, surgical segments (cervical, thoracic, lumbosacral), timing (elective vs emergency), procedure type (decompression alone vs decompression with stabilisation), indications (trauma, degenerative, infection, deformity, tumour), and postoperative complications were extracted. Multivariate logistic regression with prespecified clinically relevant confounders identified predictors of complications. Results: Of 638 surgeries, lumbosacral procedures were most common (58.6%), followed by cervical (24.6%) and thoracic (16.8%). Elective surgeries accounted for 67.4%, while emergency procedures constituted 32.6%. Decompression with stabilisation was performed in 61.3% and decompression alone in 38.7%. Trauma was the leading indication (38.4%), followed by degenerative disease (34.2%), infection (14.1%), deformity (7.8%), and tumour (5.5%). The overall patient-level complication rate was 18.5% (118/638). The most common complications were surgical site infection (5.6%), dural tear (3.9%), pressure ulcers (2.8%), neurological deterioration (2.2%), implant failure (1.6%), and pulmonary complications (1.3%). Independent predictors of complications included emergency surgery (adjusted OR 2.6, 95% CI: 1.5 - 4.6), thoracic-level surgery (adjusted OR 2.2, 95% CI: 1.2 - 4.0), trauma indication (adjusted OR 2.0, 95% CI: 1.1 - 3.6), and multilevel fusion (adjusted OR 1.8, 95% CI: 1.1 - 3.2). Conclusions: Complications following spinal surgery in Nigeria occur in nearly one in five patients, with surgical site infection being the most common. Emergency procedures, thoracic-level surgery, trauma indications, and multilevel fusion are significant predictors. Targeted preventive strategies and enhanced perioperative care are urgently needed.