Short-term outcomes after anterior cervical discectomy and fusion using mJOA and NDI scores in a low- and middle-income country
Sayan Biswas, Saskia Swannack, Samuel Wiltshire, Sandip Chatterjee, K. Joshi GeorgeBackground:
Postoperative recovery following anterior cervical discectomy and fusion (ACDF) is commonly evaluated using the modified Japanese Orthopaedic Association (mJOA) score and/or neck disability index (NDI). Here, we examined the post-operative trends in mJOA and NDI outcomes following ACDF in a neurosurgical center located in a low- and middle-income country (LMIC).
Methods:
Twenty-three demographic and clinical variables were collected. The primary outcome was good prognosis at 6 months, defined as a ≥50% change in post-operative mJOA. Secondary outcomes included minimum clinically important difference (MCID) in mJOA (≥2-point improvement) and NDI (≥7-point reduction). Patients averaged 54 years and were predominantly male (77.5%) undergoing single-level ACDF (67.5%).
Results:
Median mJOA improved from 8 pre-operatively to 13 at 6 months and 15.5 at 1 postoperative year. MCID for mJOA was achieved in 84.8% of patients at 6 months and 90% at 1 year. Median NDI decreased from 25 pre-operatively to 17 at 6 months and 15 at 1 year. MCID was achieved in 66.7% and 85% at these two latter time intervals, respectively. Multilevel disease and gait disturbance were both negative prognostic factors at 6 postoperative months.
Conclusion:
In a LMIC neurosurgical setting, ACDF was associated with sustained improvements in mJOA and NDI scores.