Predictors of Surgical Outcome After Anterior Cervical Discectomy and Fusion: A Prospective Middle Eastern Cohort Study

TL;DR

This study finds that early surgery and younger age improve outcomes after cervical spine surgery for disc prolapse.

Contribution

The study identifies symptom duration and age as significant predictors of surgical outcomes in a Middle Eastern cohort undergoing ACDF.

Findings

Patients with symptoms lasting less than six months had the best outcomes after ACDF.

Age ≥60 years was associated with lower improvement rates compared to younger age groups.

Gender did not significantly influence surgical outcomes.

Abstract

Background

Cervical disc prolapse is a common cause of radiculopathy and myelopathy. Anterior cervical discectomy and fusion (ACDF) is the standard surgical treatment, but prognostic factors such as age and the duration of symptoms remain debated. This study evaluated outcomes of ACDF and analyzed predictors of recovery.

Methods

Sixty-two patients with cervical disc prolapse underwent ACDF at a single tertiary neurosurgical center. Demographic data, clinical features, operative levels, outcomes, and complications were documented. Outcomes were categorized as improved, unchanged, or deteriorated at final follow-up. Patients were stratified by age (30-39, 40-49, 50-59, and ≥60 years), gender, and symptom duration (<6 months, 6-24 months, and >24 months). Chi-square (χ²) tests were used for associations, with significance at p < 0.05.

Results

The mean age was 49.3 years (range: 31-67); there were 22 men and 40 women. The most common level affected was C5-C6 in 36 (57.1%) patients. Presenting symptoms included upper limb sensory complaints in 54 (87.1%) patients and neck pain in 50 (80.6%) patients. At final follow-up, 52 (83.9%) patients improved, eight (12.9%) remained unchanged, and two (3.2%) deteriorated. The duration of symptoms significantly affected outcomes: all patients treated within six months (22) improved, compared with 26 out of 32 (81.3%) in those with 6-24 months and four out of eight (50%) with >24 months (χ² = 11.18; p = 0.0037). Age was also significant, with four out of eight patients aged ≥60 years showing lower improvement (50%) compared with 24 out of 26 (92.3%) in the 50-59 age group (χ² = 8.31; p = 0.040). Gender did not influence outcome (18 of 22 men {81.8%} versus 34 of 40 women {85%}, p = 0.61). Complications occurred in six of 62 patients (9.7%), including transient dysphagia in four (6.5%) and transient hoarseness in two (3.2%), with no mortality.

Conclusion

ACDF is an effective and safe treatment for cervical disc prolapse, achieving high neurological recovery with a low complication rate. Outcomes are significantly influenced by symptom duration and patient age but not by gender. Early surgical intervention provides the most favorable prognosis, supporting prompt referral and management in suitable candidates.

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