Patterns and clinical outcomes of surgically treated cervical spine degenerative disc disease at the Moi Teaching and Referral Hospital, Eldoret

Abstract

Background: Degenerative disc disease is a condition characterized by wear and tear of the intervertebral disc. It occurs in a variety of clinicopathologic conditions including cervical spondylosis. Locally, there is no data describing the patterns and clinical outcomes of surgically treated cervical spine degenerative disc disease. Objective: To determine the patterns and clinical outcomes of surgically treated cervical spine degenerative disc disease. Methods: This was a prospective cross sectional study involving all patients who underwent cervical spine surgery secondary to degenerative disc disease at the Moi Teaching and Referral Hospital, Eldoret during the period October 2014 and July 2015. Data variables collected were biodata, clinical parameters, surgical procedures done, complications and the clinical outcome. It was entered into a structured questionnaire. Data was analyzed using SPSS version 19.0 and presented in form of graphs and tables. Ethical approval was obtained from MTRH before the study commenced. Results: There were a total of 44 patients sampled. The mean age was 56±13 years. Thirty three patients (75%) were male. Twenty three patients (52%) were doing manual labour while nine (21%) were doing clerical work. Twenty five (57%) had experienced radiculopathy for more than 6 months. Myelopathy was present in eleven (25%) while four (9%) had upper limb weakness for more than six months. Seventeen patients (39%) had radiculopathy while fifteen (36%) had neck pain for less than six months. History of previous neck trauma was present in twenty eight patients (64%), Family history of DDD was present in nine (21%), alcohol intake was present in eighteen (41%) while sixteen (36%) reported smoking cigarette. Thirteen patients (30%) had C5/C6 disc level affected, three patients (7%) had C3/C4, five (11%) had C4/C5. The main indications for surgery were severe pain/ radiculopathy present in thirty nine (89%) and failed conservative management in sixteen (36%). The median preoperative visual analogue scale for pain was 6 (IQR: 5 to 7) while the twelve week post-operative pain score was 2 (IQR: 1 to 3) with significant median difference being -4 (IQR: -5, to -3). There was significant differences in the VAS score outcome measure across the age groups, (p=0.018) and gender, (p=0.035). Male patients and the elderly had smaller change compared to female and younger patients respectively. Post surgery MRS score significantly reduced (p<0.0001) with median preoperative MRS score being 3(IQR: 2 to 4) while the median twelve week post operative MRS score was 1 (IQR: 0 to 1). Post-surgery complications were reported in nine patients (20%). Three patients, (7%) had dysphagia while another four (9%) had neck pain. Three (7%) had post-operative haematoma while two patients (5%) died. Conclusion: cervical DDD is common in male. Trauma was the most common predisposing factor for CDDD. Pain/ Radiculopathy was the most presenting symptom and indication for surgery. ACDF with cage and plate was the most common operative procedure and associated with improved outcomes.