Identification, validation, and prediction of longitudinal recovery phenotypes in degenerative cervical myelopathy: analysis of prospective cohorts and a randomised controlled trial

This study pooled three prospective DCM cohorts (1047 patients treated surgically) and used a statistical clustering method to look for patterns in how neurological function (mJOA), neck disability (NDI), and physical quality of life (SF-36 PCS) changed together over the first postoperative year. Three trajectories emerged: minimal responders (17%, little improvement), neck-pain responders (50%, big NDI gains but modest neurologic gains), and global responders (33%, improvement across all domains); global responders had far higher odds of reaching a clinically important improvement in mJOA (OR 10.90, 95% CI 6.15-19.32) compared with minimal responders.

AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing

Why it mattersThis challenges the traditional practice of tracking DCM recovery by neurologic score alone and suggests surgeons should also monitor neck pain/disability and quality-of-life trajectories to counsel patients about expected recovery patterns.

Presenting this at rounds? Start here

• ?If a patient's baseline profile predicts they are likely to be a 'neck pain responder' with only modest neurological gain, how should that change preoperative counseling about expected outcomes?
• ?Should surgical approach (anterior vs posterior) be chosen partly based on its association with different recovery phenotypes, or is this association too confounded by baseline disease severity to act on?