Neck Pain Is a Key Determinant of Health-Related Quality-of-Life Outcome in Degenerative Cervical Myelopathy

Health-related quality of life (HRQoL) in patients with degenerative cervical myelopathy (DCM) ranks among the lowest across chronic medical conditions. We aim to evaluate the impact of neck pain on postoperative HRQoL after surgical decompression for DCM.

We conducted a retrospective analysis of a multicenter international DCM cohort comprising 1047 patients enrolled from 2005 to 2021. Neck pain severity was assessed using the pain intensity subdomain of the Neck Disability Index. Baseline and 1-year HRQoL scores measured using the SF-36 physical component summary (PCS) and mental component summary (MCS) were compared between neck pain and no neck pain cohorts. Multivariable regression models, adjusted for key clinical covariates, were used to examine the association between neck pain severity and HRQoL.

Neck pain was present preoperatively in 81.5% of patients. The neck pain group had significantly lower PCS (34.72 ± 9.02 vs 39.56 ± 10.20, P < .001) and MCS scores (40.59 ± 11.73 vs 45.64 ± 12.86, P < .001) compared with the no neck pain group. At 1 year postsurgery, 35.5% reported being pain-free. Increasing neck pain severity was associated with progressively lower PCS (exp β = -3.64, -7.45, and -10.47 for mild, moderate, and severe pain) and MCS scores (exp β = -2.96, -7.69, and -11.80). Persistent moderate and severe neck pain at 1 year independently predicted failure to achieve minimal clinically important difference for PCS [odds ratio = 0.57 (95% CI 0.39-0.83, P < .05) and 0.37 (95% CI 0.25-0.55, P < .05), respectively] and MCS [odds ratio = 0.49 (95% CI 0.34-0.71, P < .05) and 0.60 (95% CI 0.41-0.88, P < .05), respectively]. Model fit predictions for 1-year HRQoL were improved with inclusion of neck pain scores (PCS: χ2 = 37.21, MCS: χ2 = 19.18, both P < .0001).

Neck pain is highly prevalent among patients with DCM and is independently associated with poorer postoperative HRQoL. While surgery restores neurological function, optimizing patient-reported outcomes requires adjunctive strategies specifically targeting neck pain.