The effect of preoperative psychological state on postoperative outcomes of anterior cervical approach in cervical spondylotic myelopathy: a retrospective case‒control study.

Objective: To explore the impact of the preoperative psychological state on postoperative clinical outcomes in patients with cervical spondylotic myelopathy(CSM) treated surgically by the anterior cervical approach.

Methods: A retrospective study of 158 CSM patients undergoing anterior cervical surgery analyzed the impact of preoperative psychological state, measured by the preoperative mental state quality of life score (SF-12 MCS score). Patients were split into distress and non-distress groups for comparison. General data and clinical scores such as the Japanese Orthopaedic Association (JOA) score, neck disability index (NDI) score, visual analog scale (VAS) score, as well as patient satisfaction were assessed preoperatively and at final follow-up. Logistic analysis identified factors influencing psychological improvement in the distress group.

Results: Among of 158 patients, 49 (31%) presented with preoperative psychological distress. This cohort experienced longer hospital stays and demonstrated poorer preoperative scores for NDI, physical health (PCS), and mental health (MCS). Both groups achieved significant and equivalent improvement in physical outcomes (JOA, VAS, NDI). Although the distress group showed greater improvement in MCS scores, their postoperative satisfaction rate (81.6%) was numerically lower than that of the non-distressed group (89.9%), a difference that was not statistically significant. A higher final mental health score was associated with a better preoperative MCS, a longer follow-up period, and male sex.

Conclusions: Patients with CSM exhibit a high incidence of psychological distress. Anterior cervical surgery effectively improves both physical symptoms and mental health outcomes in these patients. Key factors associated with poorer mental health recovery include a low preoperative MCS score, shorter follow-up duration, and female sex. Importantly, preoperative psychological distress does not negatively affect the improvement in neurological function or overall postoperative satisfaction.