Cervical compressive myelopathy in Africa: a systematic review of clinical presentation, diagnostic pathways, surgical management, and outcomes

BACKGROUND: Degenerative cervical myelopathy (DCM) is the leading cause of non-traumatic cervical spinal cord dysfunction globally; however, broader cervical compressive myelopathies remain poorly characterised across African settings. This systematic review evaluated the clinical presentation, diagnostic pathways, surgical management, and outcomes of cervical myelopathy across African settings. METHODS: This review was conducted according to PRISMA 2020 guidelines. PubMed, African Journals Online (AJOL), Google Scholar, and African neurosurgical registries were searched from inception to 25 December 2025. Both degenerative and non-degenerative compressive cervical myelopathies were eligible where cervical cord compression was clearly described. Data were synthesised narratively because of substantial methodological and clinical heterogeneity. Risk of bias was assessed using Joanna Briggs Institute (JBI) appraisal tools. RESULTS: Fifteen studies involving 315 patients from four African sub-regions met inclusion criteria. Degenerative cervical spondylotic myelopathy constituted the predominant aetiology across major surgical cohorts, although several studies included mixed myelopathy populations or rarer compressive causes such as fluorosis-associated OPLL and CPPD-related ligamentum flavum calcification. Patients consistently presented late, with prolonged symptom duration (12-48 months) and advanced neurological impairment, commonly Nurick grade ≥ 3. Motor deficits and gait disturbance were the dominant presenting features, while sphincter dysfunction reflected advanced disease. Diagnostic pathways evolved from plain radiography and myelography to increasing MRI utilisation; however, MRI scarcity remained a major barrier contributing to delayed diagnosis. Surgical decompression, via anterior cervical discectomy and fusion or posterior laminectomy, produced neurological improvement in 50-97.6% of patients. Earlier presentation and lower preoperative severity were the strongest predictors of favourable recovery. No included study demonstrated low overall risk of bias. CONCLUSION: Cervical myelopathy in Africa is characterised by delayed presentation and limited diagnostic resources, yet surgical decompression appears feasible and is associated with neurological improvement in reported cohorts. Expansion of MRI access, earlier referral systems, and prospective multicentre registries are required to improve outcomes and strengthen the evidence base.