title: Elective non-instrumented anterior cervical diskectomy and fusion in Ghana: a preliminary report.
abstract: BACKGROUND
  This study is a retrospective analysis of forty-one consecutive patients who underwent elective single or multilevel anterior cervical diskectomy and fusion (ACDF) in Ghana. All the patients had been followed up for at least six months.
  
  
  METHODS
  The medical records of forty-one consecutive cases were analysed retrospectively. The parameters reviewed included patient demographics and presentations, number of fusion levels, complications and clinical outcome.
  
  
  RESULTS
  Non-instrumented ACDF constituted 22% of all the neurosurgical procedures performed during the study period. A total of 41 patients underwent the procedure. Seventy-eight percent of the patients were male; the mean age of all the patients was 52 years; follow-up was for an average of 21 months. Preoperative assessment revealed that 98% had myelopathy and 2% had radiculopathy only. No patient was operated on for only pain. There were no repeat operations performed. All levels operated on were fused for a total of 67 levels; 37% at one level only and 63% at two levels; no patient was fused or operated on at three levels. Ninety percent of the fusions were at the C4-5 and C5-6 levels. The mean ages of males and females fused at one level only were 48 and 60 years respectively; the difference was statistically significant (P<0.05). For patients fused at two levels; 81% were males and 19% were females, the difference was statistically significant (P<0.05). However, there was no statistical difference between the ages of males and females operated on at two levels (P>0.05). In addition there was no statistical difference between the ages of males operated on at one level or two levels nor was there a difference between the ages of females operated on at one or two levels (P>0.05). The mean preoperative Nurick grade was 2.3 (SD, 1.9); the mean Nurick grade postoperation was 1.3 (SD, 1.3). The difference is significant (P<0.001). There was also a significant relationship between the preoperative and postoperative Nurick grades for males operated on at either one or two levels (P<0.01); however none could be demonstrated for females (P>0.01). The total operative complication rate was 12%; the most common complication was graft/donor site infection (7%). There was no operative or postoperative mortality. Eighty six percent of the patients had an excellent or good clinical outcome as defined by Odom's criteria. Of the 34% who did not have excellent or good clinical outcome, follow up radiologic studies showed excellent graft fusion in all of them.
  
  
  CONCLUSIONS
  The majority of patients undergoing non-instrumented ACDF in Ghana have cervical myelopathy involving two cervical levels. However, a large majority of them have excellent or good clinical results after surgery. The most common complication is graft/donor site infection.
authors.affiliation: Tema International Neurocenter, Narh-Bita hospital, Tema, Ghana.
authors.forename: N B
authors.initials: NB
authors.lastname: Andrews
authors.forename: H L
authors.initials: HL
authors.lastname: Lawson
authors.forename: T L
authors.initials: TL
authors.lastname: Odjidja
mesh_terms: D002574:Cervical Vertebrae; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods*; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005869:Ghana; D006801:Humans; D007085:Ilium / Q000637:transplantation; D007405:Intervertebral Disc Displacement / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013117:Spinal Cord Compression / Q000209:etiology; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome