Prevalence and Surgical Outcomes of Neuropathic Pain in Degenerative Cervical Myelopathy

Study Design. Prospective multicenter cohort study. Objective. To evaluate the prevalence, clinical characteristics, and surgical outcomes of neuropathic pain in patients with degenerative cervical myelopathy (DCM), using the Neuropathic Pain Symptom Inventory (NPSI). Summary of Background Data. Neuropathic pain is increasingly recognized as a major determinant of quality of life (QOL) in DCM. However, few prospective studies have comprehensively evaluated its distribution, severity, and postoperative trajectory. Methods. A total of 816 DCM patients from 10 institutions were prospectively enrolled. Preoperative and 2-year postoperative assessments included the NPSI, cervical Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS), and 36-Item Short Form Health Survey (SF-36). Correlation and multiple regression analyses were performed to identify associations between NPSI scores and QOL, as well as predictive factors for postoperative improvement. Results. Preoperatively, 88.5% of patients reported symptoms of neuropathic pain, with paresthesia/dysesthesia being the most prominent subtype. At 2 years postoperatively, all NPSI subdomains showed significant improvement ( P <0.001), though paresthesia/dysesthesia remained most persistent. Higher preoperative NPSI scores were significantly associated with greater postoperative pain reduction (β=−0.556, P <0.001). Total NPSI scores significantly correlated with all SF-36 subdomains both before and after surgery (all P <0.001), indicating a strong relationship between pain and QOL. Conclusion. This study provides the first large-scale prospective evaluation of neuropathic pain in DCM. While neuropathic pain is prevalent and improves with surgery, residual symptoms—especially paresthesia/dysesthesia—remain common and impactful. These findings highlight the importance of individualized postoperative pain management strategies to optimize long-term QOL.