Abstract :

Background: Cervical spondylotic myelopathy (CSM) is a leading cause of spinal cord dysfunction. Both anterior cervical discectomy and fusion (ACDF) and posterior decompression with instrumented fusion are established surgical approaches, but comparative data from Nigerian populations remain limited. This study compared clinical outcomes, perioperative parameters, and complications between ACDF and posterior instrumented fusion for CSM at the National Orthopaedic Hospital Dala (NOHD), Kano, Nigeria.

Methods: A retrospective comparative study reviewed records of 85 patients who underwent surgical decompression for CSM between January 2018 and December 2024. Patients were divided into two groups: ACDF (n=48) and posterior decompression with instrumented fusion (n=37). Data extracted included demographics, operative parameters, complications, and outcomes assessed by modified Japanese Orthopaedic Association (mJOA) score and Neck Disability Index (NDI) at baseline, 6 months, and 12 months post-surgery. Recovery rate was calculated using the Hirabayashi formula.

Results: The ACDF group had younger mean age (54.2 ± 9.8 vs. 62.6 ± 11.4 years; p=0.001) and fewer levels fused (1.8 ± 0.6 vs. 3.4 ± 0.8; p<0.001). ACDF was associated with shorter operative time (182 ± 46 vs. 236 ± 62 minutes; p<0.001), lower blood loss (210 ± 95 vs. 450 ± 240 mL; p<0.001), and shorter hospital stay (5.2 ± 2.4 vs. 8.4 ± 3.2 days; p<0.001). Both groups achieved significant mJOA improvement at 12 months: ACDF from 10.8 ± 2.4 to 14.2 ± 2.1 (p<0.001); posterior from 9.6 ± 2.6 to 13.1 ± 2.3 (p<0.001). Mean recovery rates were 56.8 ± 22.4% for ACDF and 48.6 ± 24.2% for posterior (p=0.12). NDI improved from 46.8 ± 14.2% to 24.6 ± 12.4% in ACDF and from 52.4 ± 15.6% to 29.8 ± 14.2% in posterior (p=0.08). Complication rates were 12.5% (ACDF) and 21.6% (posterior) (p=0.26). ACDF complications included dysphagia (6.3%) and graft-related (2.1%); posterior complications included C5 palsy (5.4%) and wound infection (8.1%).

Conclusion: Both ACDF and posterior instrumented fusion achieve significant neurological improvement in CSM patients at NOHD Kano. ACDF is associated with shorter operative time, less blood loss, and shorter hospital stay, while posterior approaches are preferred for multilevel disease and in older patients. Surgical approach should be individualized based on pathology, levels involved, and patient factors.

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Keywords :

ACDF, Cervical spondylotic myelopathy, comparative study, Kano, Nigeria., patient-reported outcomes, posterior cervical fusion

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