When I meet Dr Chege Mwangi, 43, an orthopaedic and spine surgeon at the Kenai Orthopaedic and Spine Centre, I’m greeted not by high-tech medical gadgets or an extravagant office, but by his warm smile and calm demeanor at the door.
His office is modest, featuring a simple hospital bed, a pillow, a table, and the steady hum of a whirring fan. On his desk lie two essential tools of his trade: a reflex hammer, used to test deep tendon reflexes, and a spinal goniometer, an instrument crucial for measuring angles and guiding screw placement during complex spine surgeries.
The room reveals little about the gravity of the procedures he performs, where one wrong move can drastically change a patient’s life. As we begin the interview, I feel a mix of awe and disbelief. I understand the critical nature of his work, yet I am still trying to comprehend the intricacies and life-altering impact of spine surgery.
Because of this complexity, spine surgeries can take long hours. Dr Mwangi elaborates, "For example, if I'm correcting a deformity, such as scoliosis, where a patient has a bent spine, that surgery can take me sometimes even 12 hours or more.
Additionally, when we are removing tumors, growths, or cancers from the spinal cord, those surgeries can also take many hours. Therefore, proper training is essential for delivering excellent healthcare. In medicine, our first principle is to 'do no harm.'"
How did you get here?
To become a doctor, you first need to complete an undergraduate programme in Medicine and Surgery, which lasts for six years. I attended Moi University for this training. Afterward, you undergo an internship, and then you can pursue a master's degree or fellowship in orthopedic surgery, which typically takes five years.
Once I completed my orthopedic surgery training, I returned to school for several more years to specialise as a spine surgeon.
Orthopedic surgery is a specialisation, while spine surgery is a subspecialisation within that field. I studied in both Egypt and South Africa to qualify as a spine surgeon.
What inspired you to do this sub-speciality?
When I was training, I initially wanted to become an engineer. However, in high school, I read the books 'Think Big' and 'Gifted Hands' by Ben Carson, which inspired many aspiring doctors, including me. As a result, I shifted my focus and decided to pursue a career as a neurosurgeon.
During my internship at Kijabe Hospital, I excelled in obstetrics and gynecology, even receiving a scholarship that I ultimately declined. The reason for my decision was that I had witnessed several spine surgeries where patients with spinal fractures or paralysis were able to walk again after their operations. This immediate gratification drew me toward spine surgery.
One particular case stands out: we operated on a patient who had been paralysed following a road traffic accident. Remarkably, just five days after the surgery, he was walking with crutches and eventually made a complete recovery. I still keep in touch with him, and I am happy to say he is doing well to this day.
So, can I deduce that there's no direct spine surgery course?
There are two routes that you can follow. One is becoming an orthopaedic surgeon and then you subspecialise in spine surgery. The other pathway is you do a Master's in neurosurgery then after subspecialise in spine surgery.
How many surgeries do you typically do in a week?
Roughly between 12 and 20 surgeries including fracture, and joint replacements. But for spine that's around four surgeries.
When you are operating a spine, how many layers are you cutting?
You go through multiple layers before reaching it. First, you cut through the skin. Beneath the skin lies subcutaneous fat. Below that is fascia, a thick covering that encases the muscles. After the fascia, you encounter the muscles, which you need to separate to access the bone.
The bone protects the spine, so you may need to remove a piece of the bone to reach the spine itself. There is also another layer, the yellow ligament, which is a membrane that covers the spine.
So, how many layers are cut during this procedure? To be honest, it can be quite a few, and it’s easy to lose count.
Once you reach the spine, it is surrounded by the dura mater, which consists of three membranes. This layer contains the cerebral spinal fluid that bathes the spine.
Orthopaedics and Spine Surgeon Dr Chege Mwangi during the interview at his office in Thika town on March 31, 2025.
Photo credit: Lucy Wanjiru | Nation Media Group
What are the spine injuries that you majorly deal with and which gender is most susceptible?
The main focus of my work is decompression surgery, which involves relieving pressure on the spine. Most patients come to me with severe lower back pain and radiculopathy, which is pain that radiates down the leg and can lead to loss of bladder control.
This condition is known as Cauda Equina Syndrome and is considered a spinal emergency.
The majority of these patients are women between the ages of 20 and 70, likely due to factors related to ergonomics, such as heavy labour or long hours of sitting. Another common cause of spinal issues is fractures, which often result from accidents, including road traffic incidents or construction site mishaps. These injuries typically affect men aged 20 to 45.
I also work with patients who have tumors, cancers, or growths in the spine that put pressure on the spinal cord or nerves. Most spinal cancers are metastatic, originating from other parts of the body, although there are also primary spine tumors.
Finally, I perform corrective spine surgery for patients with spinal deformities, such as scoliosis—a condition where the spine curves sideways—and kyphosis, which is characterised by an excessive outward curvature of the spine, particularly in the upper back.
What is the most rewarding aspect of your career?
When I operate on a patient who is paralysed and see them walking afterward, it brings me a deep sense of fulfillment. For example, when I perform surgery on someone with Cauda Equina Syndrome, and they wake up from anesthesia without pain and can regain bladder function, it is incredibly rewarding.
I also find great satisfaction in seeing patients return to their normal work after suffering from debilitating conditions. For instance, I treat individuals who have experienced spinal cord injuries from road traffic accidents where bone fragments are penetrating the spinal cord.
After removing those fragments, many patients regain their function, which is profoundly fulfilling.raffic accidents, where bone fragments are piercing the spinal cord — I remove them, and the patients regain function...That is very fulfilling.
What skills are crucial for a spine surgeon?
You should possess excellent fine motor skills, concentration, coordination, dexterity, and training. A significant amount of time is required for training and retraining.
What are the challenges you've faced so far?
As a spine surgeon, you often encounter challenging situations with patients. For instance, when a patient arrives with a completely transected spinal cord—perhaps due to a road traffic accident—there is little you can do beyond stabilising the spine.
In such cases, the spinal cord is severed into two, and unfortunately, this means the patient will likely remain paralysed for the rest of their life, unable to regain any power or sensation in their legs.
Another common scenario involves patients whom you want to help, but you face limitations, such as inadequate facilities or financial constraints that prevent them from undergoing necessary surgery.
There are also times when you prepare thoroughly for a procedure, but upon opening the spine, you discover a condition that differs from your initial assessment. For example, you might expect to find an infection or tuberculosis, only to uncover a tumor—cancer. This presents a significant challenge, as you must not only address the spine but also consider additional treatments like chemotherapy or radiotherapy.
Additionally, there is often a lack of proper rehabilitation services for patients who are paralysed. Many require occupational therapy, physiotherapy, special assistive devices, and a supportive environment to achieve effective rehabilitation.
What advice would you give to aspiring spine surgeons?
The market is wide. The patients are many. The field is wide. Because even in spine surgery itself, there are other sub-specialisations. You can decide to do adults, paediatrics, deformity corrections.
How do you prepare for a complex spine surgery?
First, it's essential to have a thorough understanding of the disease you're treating. This knowledge will guide you in determining your approach. To achieve this, you need to conduct imaging studies such as X-rays, CT scans, and MRIs. These tests will help you accurately locate the disease.
The second step is preparing for the surgery. Ensure that you have the appropriate setup, which includes a hospital with a sterile operating theater and necessary equipment like an image intensifier or X-ray machine.
When I am operating, my team must know how to position the patient and what supplies we require.
It's also important to have support services, such as qualified nursing staff and adequate physiotherapy facilities, to assist the patient in walking the day after the surgery.
Last question, how can prevent spine injuries?
When you are working, maintain a proper sitting posture. Your spine benefits from changing positions, so take a break every hour to stand and walk around. If your job requires you to stand for long periods, such as for doctors, police officers, or teachers, make sure to sit down periodically.
When lifting objects, be sure to do so without bending your spine. If you experience low back pain, consult a doctor promptly. Additionally, if you are involved in an accident, seek the help of a spine surgeon to receive appropriate treatment and improve your condition.
