Anterior cervical discectomy and fusion for subaxial cervical spine injuries; management challenges and early outcome in a neurosurgical center.

Abstract

Background: Anterior cervical discectomy and fusion (ACDF) is an effective technique in managing subaxial cervical spine injury (SCSI). The study highlights the experience and challenges of ACDF for SCSI in a subSaharan neurosurgical center.

Methods: The medical records of the patients who had ACDF for SCSI over 6 years in Memfys Hospital, Southeast Nigeria were reviewed. Relevant data collated include patient demographics, clinical presentation, radiologic images, operative management, and complications. All patients had right-sided ACDF after resuscitation. The follow-up period was at least 3 months.

Results: Eighty-one patients had ACDF, with male preponderance (8:1) and a mean age of 38.9 ± 12.4 years. Motor vehicular accident was the most common injury mechanism (71.6%), and the majority (59.5%) were ASIA A. C5/6 was the most common level of injury (40.7%), and the mean subaxial cervical spine injury classification system (SLIC) score was 7.8 ± 1.40. Fifty-eight (71.6%) patients presented late (>48 h after injury). ASIA A injuries, high SLIC score, and late presentation were associated with higher complication rates (P = 0.02, 0.000, and 0.0001). Dysphagia was the most common complication and was self-limiting. Improvement in neurological status was 84.75% and 10.4% for incomplete and complete injuries, respectively. Only 5% had access to onsite emergency medical services, three patients had comprehensive insurance, and rehabilitation services were available to 35.8% on discharge. The 30-day mortality was 8.6%.

Conclusion: ACDF for SCSI is associated with good outcomes in patients with incomplete spinal cord injury. Challenges in management in our setting were related to poor emergency medical services, late presentation, low insurance coverage, and limited rehabilitation services.