Severe neck pain among patients with Degenerative Cervical Myelopathy: An observational study from the Canadian Spine Outcomes and Research Network.

Abstract

Background context: Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. While surgical intervention is widely recognized as the primary treatment to halt disease progression and improve neurological function, its effectiveness in alleviating neck pain remains poorly understood.

Purpose: The aims of this study were to identify DCM patients that presented with severe neck pain and to compare their baseline characteristics and surgical outcomes to those who presented with less severe neck pain.

Study design/setting: This is a prospective, multicenter observational cohort study of the Canadian Spine Outcomes and Research Network (CSORN).

Sample: Patients surgically treated for DCM between 2015 and 2022 were enrolled.

Outcome measure: Baseline demographics, clinical/surgical details, PROs and mJOA were assessed.

Methods: Baseline demographics, clinical/ surgical details, preoperative PROs and mJOA were compared between the patients with severe patient-rated neck pain (NP, defined as NRS-NP ≥ 8), and those with less severe NP. Between group improvements at 12 months were assessed using ANCOVA to adjust for any baseline significant differences between groups.

Results: We included data from 725 DCM patients, 31.7 % (n=230) of whom presented with severe NP. Patients with severe NP were significantly more likely to be younger, smokers, unemployed, working rather than retired, unmarried, using pain medication, have a history of depression, have more comorbidities, and be physically less active (all p< 0.05). Baseline PROs (NRS AP and NP, NDI, SF-12 MCS and PCS and EQ5D) were significantly worse (p<0.01), but mJOA scores were similar to those without severe NP. Among patients with severe NP, mean NRS-NP improved from 8.6 (SD 0.8) to 3.9 (SD 2.9, p<0.01) at 12 months after surgery. Patients with severe NP were more likely to achieve MCID for neck pain in comparison to those without severe NP (74% vs. 33%, p<0.01), but mean NRS-NP remained worse in this subgroup (3.9 vs. 2.6, p<0.01) at one year after surgery. When adjusted for baseline characteristics, there were no differences between the 2 groups for the following PROs at 12 months post-operatively: NRS arm pain, NDI, SF-12 PCS, EQ5D. SF-12 MCS remained significantly worse among patients who presented with severe NP (p< 0.05). There was no significant difference in mJOA scores (report data) at one year after surgery.

Conclusion: Severe neck pain affects about a third of the DCM population. Most patients who presented with severe neck pain experienced substantial improvement of their neck pain after surgery. Except for mental health scores which remained worse, patients with severe neck pain experienced similar improvements in other outcome measures such as neurological function and health-related quality of life when compared to those with less severe neck pain. These findings suggest that surgical treatment not only addresses the structural causes of DCM but also provides meaningful improvements across multiple domains, underscoring its value in managing both the physical and psychosocial burdens of the disease.