Rehabilitative Repetitive Transcranial Magnetic Stimulation (rTMS) Therapy Facilitates Neuropathic Pain and Sensorimotor Functional Recovery in Degenerative Cervical Myelopathy after Surgery: A Retrospective Cohort Study

Study Design Retrospective cohort study. Objective To evaluate the therapeutic effects of postoperative repetitive transcranial magnetic stimulation (rTMS) on neuropathic pain (NP) and neurological recovery in patients with degenerative cervical myelopathy (DCM). Methods Fifty-nine DCM patients who underwent cervical decompression between 2017 and 2024. Twenty-seven received postoperative rTMS (20 Hz, 20 trains of 40 pulses at 90% resting motor threshold over the biceps brachii for 5 consecutive days) in addition to routine care, while 32 received routine care only. Pain intensity at the neck, upper limbs, and below-neck regions was assessed using the 10-cm Visual Analog Scale (VAS). NP was identified by a Douleur Neuropathique 4 (DN-4) score ≥4. Hand dexterity, myelopathy severity, and conduction function were evaluated by the 10-second grip-and-release test, modified Japanese Orthopedic Association (mJOA) scale, and somatosensory/motor evoked potentials (SSEP/MEP) respectively. Results Among patients with NP (n = 25), rTMS significantly reduced VAS pain scores in the upper limbs and below-neck regions ( P < 0.05), but not in the neck. No effect was observed in non-NP patients (n = 34). rTMS also improved hand dexterity, mJOA scores, and recovery rates compared with controls, particularly in patients with preoperative mJOA ≤14 ( P < 0.05). These benefits persisted for 6 months. However, SSEP and MEP results were comparable between groups, suggesting that rTMS did not alter cervical conduction. Conclusion Five-day postoperative rTMS was associated with NP and functional recovery in DCM, especially in severe cases, possibly by modulating higher central pathways.