360° Spine in East Africa:
Recap of a Comprehensive Global Spine Surgery Education Course at the Muhimbili Orthopaedic Institute, Tanzania
By Lisa-Marie Rajewski; Elochukwu Ibekwe, MD; Romani R. Sabas, MD; Hamisi Kimaro Shabani, MD; Zarina Shabhay, MD; David Gendelberg, MD; Roger Härtl, MD
Spinal disorders represent a major and growing cause of disability worldwide, with a disproportionate burden falling on low- and middle-income countries (LMICs).¹ In sub-Saharan Africa, the epidemiological spectrum is dominated by trauma, spinal tuberculosis, and late-presenting deformity compounded by severe deficits in surgical workforce, emergency medical infrastructure, diagnostic capacity, implant access, and nonoperative rehabilitation capacity.²,³
At the Muhimbili Orthopaedic Institute (MOI), Tanzania's national referral center for orthopedic and neurosurgical care, serves a population of more than 60 million and access to spinal implants has historically depended on out-of-pocket expenditure or external donation. Patients have to face combined direct and indirect costs for surgery that exceed household capacity for the majority of families.⁴ Data from the WCM-MOI research program have demonstrated that patients managed nonoperatively for spinal trauma face 7.39 times the odds of death compared to those treated surgically, and that inability to pay is the leading predictor of not receiving surgery.⁵ Decision-tree analysis from the same collaboration identified implant unavailability alongside fracture instability and neurological status as one of the 3 dominant determinants of surgical triage at MOI, with perioperative mortality strongly associated with delayed care. Significant delays to surgery were seen due to patients' inability to pay for implants.⁶
In 2008, Weill Cornell Medicine (WCM) established a formal academic partnership with MOI, one of the longest-running collaborations of its kind between a North American institution and a sub-Saharan African referral center. Over 15 years, the partnership has narrowed from neurotrauma-focused training to spine care encompassing
implant access programs, spinal navigation, endoscopic surgery, data registries and research publications. The 360° Spine Global Neurosurgery Course, held April 20–22, 2026, in Dar es Salaam with the foundational institutional support of NASS, is the most comprehensive single spine educational initiative of this collaboration to date. This article describes its model, curriculum, key educational findings, and framework to sustain a replicable model for comprehensive spine surgery education in Africa and other resource-limited settings.
Surgical Industry Engagement
What made the 2026 roundtable exceptional was the premier roundtable session uniting international and local surgical industry partners. Representatives from 11 organizations spanning global medical device manufacturers, endoscopic and simulation suppliers, intraoperative neuromonitoring, and regional health care and laboratory equipment distributors were all present at the roundtable, pledging concrete, actionable proposals for implant access, collaborative purchasing, and establishment of formal implant subsidy fund for acute spinal injury cases. The role of NASS in this collaboration was important: the society contributed to the design of the comprehensive curriculum, providing an organizational infrastructure that enabled industry representatives’ attendance.
Bidirectional Partnership Model
This premier NASS-led course built upon an existing 15-year collaboration between Weill Cornell Medicine and the Muhimbili Orthopaedic Institute, produced a comprehensive full spectrum spine surgery education course in East Africa. To our knowledge, the 360º Spine course represents the first of its kind in offering a multidisciplinary course featuring expert-led lectures and hands-on sessions on spine trauma, deformities, degenerative disease, minimally invasive spine surgery, research, technological advancements, and economic barriers to spine care. Previous courses held at MOI in partnership with WCM focused on general neurosurgery concepts, but none encompassed this combination of spine multidisciplinary subspecialty depth, technology integration, health economics, and industry engagement within a single three-day format. This reflects a deliberate educational philosophy: that training operative skills in isolation, without equal attention to nonoperative care infrastructure, implant access, and cost burden, risks producing surgeons who are technically prepared but limited collegially and technologically.
The course was well attended, drawing strong and sustained multidisciplinary engagement from surgeons, trainees, allied health professionals, and medical industry representatives throughout all 3 days. Faculty composition reflected genuine institutional breadth: 35 participants from 7 institutions across 5 countries (United States, Tanzania, Kenya, Pakistan, and Germany), with MOI faculty representing 26% of the total. The 3-day course featured 2 days of didactic interactive sessions at New Africa Hotel, with the last day at MOI where hands-on spine injection simulation and live surgical cases (MIS TLIF, endoscopic and open decompression, spinal injections) were done.
Research, an important core of NASS, and a major pillar of this bidirectional partnership model was also a prominent feature of the course. The course offered a platform for intercontinental collaborative data presentation on issues covering spinal cord injury, minimally invasive surgery, navigation, and pediatric scoliosis. During this course, it was mutually agreed to continue supporting active local registries to analyze cost-effectiveness, expand the collection of PROMS (Patient-Reported Outcome Measures) using locally validated tools, and gather longitudinal outcome data for endoscopic surgery.
Critical Resource Gaps Recognition
The course gave a platform for cost-analysis research presentation by MOI faculty and staff, which revealed more than 80% of patients have a hospital length of stay of 17 days with hospital costs exceeding household capacity. ⁴ It shed light on favorable cost-per-QALY ratio for surgical management of acute traumatic spinal injury via affordable sustainable implant availability, ongoing emergency physician training, and surgical training.
However, technology transfer is not equivalent to technique transfer. Surgical technology unavailability, steep learning curves, and inconsistent training remain limiting issues in spine care. Despite the introduction of spinal navigation in 2023, and a dedicated endoscopic surgery program in 2024, minimally invasive techniques account for approximately 5% of spine procedures. Limiting factors identified during the course include trained personnel and low case volume. This course offered endoscopic TLIF live surgery demonstration, with a pledge by NASS faculty to continue ongoing training and mentorship via an annual course, ongoing monthly video lectures, technique demonstration, and research collaboration.
Lastly, structured physiotherapy is nearly absent across the region: practitioners lack formal training in evidence-based spine rehabilitation techniques, validated patient-reported outcome measures are not in routine clinical use at MOI, and fewer than 20% of patients in Tanzania carry any health insurance to afford physiotherapy. More than half of acute radiculopathy pain achieved satisfactory improvement with appropriate physiotherapy without operative management. Therefore, development of evidence-based physiotherapy and rehabilitation capacity is not merely a quality of life priority, but a public health and resource stewardship imperative. Future iterations of the 360° Spine Course will include more hands-on nonoperative sessions involving physiotherapists, rehabilitation specialists, and nurses.⁸
Conclusion
The 360° Spine Global Neurosurgery Course recognizes the importance of focused, sustained global collaboration. It demonstrates that an annual multidisciplinary course led by a reputable global spine society, such as NASS, built on a foundation of knowledge exchange via lectures, hands-on training, and research, can deliver comprehensive, contextually adapted spine education, bridging the gap of high-quality spine care in resource limited settings. The 2026 course, held over 3 days, included nearly a dozen NASS faculty, 5 countries, and an industry roundtable of unprecedented scale for the field in this region. It represents a new standard for global spine surgery education. Three features are essential for replication: genuine bidirectionality in which local faculty lead and co-own the agenda with NASS support, structured industry engagement that fosters into long-lasting sustainable partnerships, and collaborative research registries.
NASS confirming its institutional support for the 2027 sequelae of the 360º Spine Course signals to the global spine community a serious, sustained model of international partnership. Tanzania and the broader East Africa region eagerly awaits the 2027 course!
Acknowledgements
The authors thanks NASS for faculty, educational material, and logistical support. Sincere thanks to staff, trainees, and faculty of the Muhimbili Orthopaedic Institute for their sustained partnership over 15 years. Further thanks to Seattle Science Foundation, Muhimbili University of Health and Allied Science, and industry representatives: Globus Medical, Brainlab, DePuy Synthes, Joimax, Cadwell, Realists Training Technologies, Kusum Healthcare, Nebula Healthcare, Anudha Limited, and East African Medtronic.
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