Surgical Outcome After Anterior Cervical Discectomy and Fusion (ACDF) in Terms of Pain and Paresthesia

Abstract

Background: Cervical disc herniation and degenerative disc disease are prevalent spinal disorders that cause significant pain and sensory deficits, often warranting surgical intervention. Anterior cervical discectomy and fusion (ACDF) is widely practiced; however, localized outcome data, particularly regarding persistent postoperative symptoms such as pain and paresthesia, remain sparse in South Asian populations. Objective: To assess the frequency and demographic correlation of pain and paresthesia three months post-ACDF in patients with cervical disc pathology, and to evaluate the statistical significance of these outcomes in relation to age and gender. Methods: A descriptive observational study was conducted at the Department of Neurosurgery, Lady Reading Hospital, Peshawar, from January 22 to April 22, 2025, including 101 patients (mean age 46.88 ± 9.92 years; 70 males, 69.3%; 31 females, 30.7%) diagnosed via MRI/CT with cervical disc herniation or degenerative disc disease. All underwent standard single-level ACDF and were evaluated postoperatively at three months using a structured questionnaire. Ethical approval was secured in accordance with the Helsinki Declaration. Data analysis was performed using SPSS v25, reporting descriptive statistics and inferential chi-square tests for association (p ≤ 0.05). Results: Among the 101 patients, 49 (48.5%) reported persistent pain and 52 (51.5%) were pain-free; 57 (56.4%) experienced paresthesia while 44 (43.6%) did not. Pain was most frequent in the 41–50 years group (n = 21; 42.9%), followed by 31–40 years (n = 13; 26.5%). Conversely, 50–60 years had the highest proportion of pain-free patients (n = 19; 36.5%). Chi-square analysis revealed no significant association between pain and age group (χ² = 4.91, p = 0.27) or gender (χ² = 1.64, p = 0.20). Paresthesia was most common in the 50–60 years age group (n = 20; 35.1%), followed by 41–50 years (n = 18; 31.6%). Similarly, no significant associations were found between paresthesia and age (p = 0.55) or gender (p = 0.51), with males comprising 66.7% (n = 38) of paresthesia cases and females 33.3% (n = 19). Conclusion: ACDF provides substantial symptomatic relief in patients with cervical disc herniation and degenerative disc disease; however, nearly half of the patients continue to report pain (48.5%) and more than half report paresthesia (56.4%) at three-month follow-up. Age and gender were not significantly associated with these symptoms, suggesting broadly consistent outcomes across demographic groups. These findings reinforce the clinical effectiveness of ACDF while highlighting the importance of postoperative counseling, symptom monitoring, and individualized rehabilitation in early recovery phases.