We study spreading dynamics of nematic liquid crystal droplets within the framework of the long-wave approximation. A fourth-order nonlinear parabolic partial differential equation governing the free surface evolution is derived. The influence of elastic distortion energy and of imposed anchoring variations at the substrate are explored through linear stability analysis and scaling arguments, which yield useful insight and predictions for the behaviour of spreading droplets. This behaviour is captured by fully nonlinear time-dependent simulations of three-dimensional droplets spreading in the presence of anchoring variations that model simple defects in the nematic orientation at the substrate.