Effect Of Body Mass Index (BMI) And Cervical Lordosis in Neurological Recovery After Anterior Cervical Decompression and Fusion for Cervical Spondylotic Myelopathy

Abstract

Cervical Spondylotic Myelopathy (CSM) is a leading cause of spinal cord dysfunction, often managed with Anterior Cervical Decompression and Fusion (ACDF). While ACDF is effective, the influence of Body Mass Index (BMI) and Cervical Lordosis on neurological recovery remains uncertain. This study evaluates the impact of these factors on postoperative outcomes. A prospective observational study was conducted at NRS Medical College from January 2023 to June 2024, including 74 patients undergoing ACDF for CSM. BMI was categorized as obese(BMI≥30) and non-obese(BMI<30), and cervical lordosis was measured using a C2–C7 Cobb angle. Loss of cervical lordosis was categorized as absent(c2-c7 Cobb’s angle > 20 degrees) and present( c2-c7 Cobb’s angle<20 degrees). Neurological recovery was assessed using modified Japanese Orthopaedic Association (m-JOA) scores at baseline, 6 weeks, 3 months, and 6 months postoperatively. Statistical analyses included correlation and regression tests, with p< 0.05 considered significant. BMI showed no significant correlation with postoperative m-JOA score improvement (p = 0.793), suggesting BMI alone is not a predictor of neurological recovery. Cervical lordosis positively correlated with preoperative neurological function (r = 0.502, p = 0.000) but did not significantly influence postoperative outcomes (p = 0.824). ACDF effectively improves neurological function regardless of BMI and cervical alignment. These findings suggest that BMI should not be a contraindication for ACDF, and preoperative cervical lordosis does not strongly predict recovery. Further long-term, multi-center studies are needed to confirm these findings.