Surgical Outcome of Anterior Cervical Discectomy and Fusion for Cervical Spine Myelopathy in Young VS Elderly Patients

Abstract

Objectives: To measure and compare the frequency of surgical outcome of ACDF in patients with cervical spine myelopathy and to compare its outcome in younger vs elderly patients. Study Design and Setting: This Descriptive study was conducted at the Department of Neurosurgery, Ayub Teaching Hospital Abbottabad, Pakistan, from February 2025 to June 2025. Methodology: Sixty-two patients, diagnosed cases of CSM, meeting our inclusion criteria were randomly recruited and allocated into younger vs elderly groups based on age. Data were entered on a pre-validated, questionnaire and were followed up post-operatively to check for outcome using the ODOMS criteria, visual analogue scale and rate of complications. Results: n=62 patients underwent ACDF for Cervical myelopathy n=32 elderly and n=30 young patients. Degenerative spondylosis was the most common etiological factor causing CSM in elderly (96.9%) while cervical spine stenosis (50.0%) and traumatic aetiologies (30%) were the causes reported in younger lot. Younger patients had more pronounced motor deficit (30%), spastic gait (26.7%) and higher incidence of severe Ranawat classification iiia/b (50%vs 25%). Pre ope mJOA and VAS didn’t differ significantly (6.9 vs 8.4 and VAS, 9.5 vs 9.3). Elderly patients achieved comparable or better outcomes than their younger counterparts, with favourable ODOMS grade (Excellent/good) 90.6% vs 73.3% with short hospital stay i.e. (8.6 vs 11.2 +- days). Post ope VAS showed a lower trend toward elderly (2.5 vs 3.03) though the difference didn’t reach significance. Complications rate was statistically similar across both groups however respiratory issues were reportedly more common in younger population (16.7% vs 0%). Conclusion: Cervical spine myelopathy is as commonly reported in younger as is, in elderly population though the etiological differences are prominent. Younger patients tend to have traumatic pathologies superimposed on already stenosed C spine. That’s why younger lot though report early, as compared to their elder counterparts, tends to have poor prognosis with long hospital stay, poor VAS and ODOM and more risk of post-operative complications. While the elderly patients with their co morbidities since are dealt with electively they tend to have an overall better surgical outcome.  The study concludes overall favourable outcome for elderly population undergoing ACDF for CSM, and would urge to scan the younger lot electively at an early age with regular follow ups and intensive and multimodal care where and when its needed especially when there’s respiratory compromise.