Surgical Management of Cervical Disc Herniation in a Resource-Limited Setting: Outcomes and Challenges.

Original Article

Abstract

Objectives: To evaluate clinical and functional outcomes and identify perioperative and health-system challenges among patients undergoing surgical treatment for symptomatic cervical disc herniation in a resource-limited tertiary-care hospital.

Methodology: This observational study was conducted in the Department of Neurosurgery, MMC/BKMCMardan, from January to December 2025. We included 100 consecutive adult patients with MRI-confirmed symptomatic cervical disc herniation who underwent surgical treatment. We retrospectively extracted demographic, clinical, radiological, operative, postoperative, and health-system data from medical records. We assessed pain and functional disability using the Visual Analog Scale (VAS) and Neck Disability Index (NDI), respectively, before surgery and at 6-month follow-up.

Results: Among 100 patients, 62% were male, and 38% were female, with a mean age of 47.8 ± 11.4 years. The most frequently affected level was C5–C6 (44%), followed by C6–C7 (31%). Radiculopathy was present in 71% of patients and myelopathy in 29%. We performed ACDF in 82% of patients, while 18% underwent discectomy without fusion. Mean VAS decreased from 7.6 ± 1.2 preoperatively to 2.3 ± 1.1 at 6 months, while mean NDI decreased from 34.5 ± 8.7 to 12.8 ± 5.4 (both p<0.001). Postoperative complications occurred in 11% of patients. Documented health-system barriers included delayed MRI access (27%), implant shortages (19%), and operating-room scheduling delays (22%).

Conclusion: In this single-center retrospective cohort, surgical treatment of symptomatic cervical disc herniation was associated with substantial improvements in pain and functional disability at 6 months. Delays in MRI access, implant availability, and operating-room scheduling represented important health-system challenges.