Recovery Trajectories After Surgery for Degenerative Cervical Myelopathy: Results of a Multicenter Prospective Study.

Abstract

Prospective multicenter cohort study. Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord dysfunction in adults, yet the duration and trajectory of postoperative recovery remain incompletely defined. Although registry studies suggest that most recovery occurs within the first postoperative year, comprehensive multicenter evidence using patient-reported outcomes (PROs) is limited. This multicenter study included 935 patients who completed at least one clinical or radiographic assessment at 24 months. Clinical characteristics, radiographic parameters, and PRO instruments-including VAS, JOACMEQ, SF-36, and NPSI-were collected preoperatively and at 6, 12, and 24 months postoperatively. Longitudinal changes were analyzed using linear mixed-effects models adjusted for demographic and clinical covariates. Most PROs showed substantial improvement by 6 months and remained largely stable through 24 months. Neck and shoulder pain and pain from the chest to the toes plateaued after early improvement, whereas arm and hand symptoms continued gradual gains. JOACMEQ domains related to cervical function, upper extremity function, and QOL remained stable, while lower extremity function declined modestly and bladder function returned to near-baseline by 24 months. SF-36 PCS/MCS and NPSI scores improved early and were maintained. Radiographically, cervical lordosis showed a slight postoperative decrease without further progression, and cervical ROM decreased after surgery but remained stable. Substantial recovery was already evident by the 6-month assessment, with minimal additional gains thereafter. These findings highlight the importance of early postoperative assessment and may guide optimization of follow-up strategies and perioperative care.