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Impact of surgeon experience on surgical outcomes after posterior decompression for degenerative cervical myelopathy: A prospective multicenter study

Spinal Cord (2026)Cite this article

Subjects

Abstract

Study Design

Prospective multicenter cohort study.

Objectives

To investigate how surgeon experience influences surgical, radiologic outcomes, and patient-reported outcomes (PROMs) after posterior decompression in patients with degenerative cervical myelopathy (DCM).

Setting

The multiple institutions in Japan.

Methods

We prospectively enrolled 775 patients with DCM who underwent posterior decompression at 10 academic institutions in Japan. Surgeries were performed by either board-certified spine (BCS) surgeons or non-BCS (NBCS) surgeons under direct BCS supervision. Outcomes included surgical parameters, radiographic findings, physician-reported measures, and PROMs, such as the JOA score, Visual Analog Scale (VAS) for pain, JOACMEQ, and SF-36 scores, assessed preoperatively and at 2 years follow-up.

Results

Baseline demographics were comparable between groups, except for a higher prevalence of diabetes in the BCS group (p = 0.044). The NBCS group had longer surgical duration (91.1 ± 33.1 minutes vs. 109.4 ± 51.8 minutes, p < 0.001) and greater blood loss (33.7 ± 56.3 mL vs. 45.9 ± 79.4 mL, p = 0.018), despite fewer operated laminae (4.1 ± 1.1 vs. 3.8 ± 1.2, p < 0.001). Perioperative complication rates and radiographic outcomes at 2 years were similar between groups. Both groups showed significant improvements in JOA scores, VAS, all JOACMEQ domains, and most SF-36 subscales, with no significant differences between groups.

Conclusion

Posterior decompression for DCM can achieve favorable results when performed by NBCS surgeons under BCS supervision, with outcomes equivalent to those of BCS surgeons. These findings support the safety and educational value of supervised training in spine surgery.

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Data availability

The datasets generated and/or analyzed in this study are available from the corresponding author on request.

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Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan

    Toshiki Okubo, Narihito Nagoshi, Takahito Iga, Kazuki Takeda, Masahiro Ozaki, Satoshi Suzuki, Morio Matsumoto, Masaya Nakamura & Kota Watanabe

  2. Keio Spine Research Group (KSRG), Tokyo, Japan

    Toshiki Okubo, Narihito Nagoshi, Junichi Yamane, Hitoshi Kono, Yoshiomi Kobayashi, Tatsuya Yamamoto, Kazuya Kitamura, Takeshi Ikegami, Yosuke Horiuchi, Takahito Iga, Kazuki Takeda, Masahiro Ozaki, Satoshi Suzuki, Morio Matsumoto, Masaya Nakamura & Kota Watanabe

  3. Department of Orthopaedic Surgery, Keiyu Hospital, Kanagawa, Japan

    Junichi Yamane

  4. Department of Orthopaedic Surgery, Keiyu Orthopedic Hospital, Gunma, Japan

    Hitoshi Kono

  5. Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan

    Yoshiomi Kobayashi

  6. Department of Orthopaedic Surgery, Japan Red Cross Shizuoka Hospital, Shizuoka, Japan

    Tatsuya Yamamoto

  7. Department of Orthopaedic Surgery, National Defense Medical College, Saitama, Japan

    Kazuya Kitamura

  8. Department of Orthopaedic Surgery, Fussa Hospital, Tokyo, Japan

    Takeshi Ikegami

  9. Department of Orthopaedic Surgery, Japan Community Health Care Organization Saitama Medical Center, Saitama, Japan

    Yosuke Horiuchi

Authors
  1. Toshiki Okubo
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  2. Narihito Nagoshi
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  3. Junichi Yamane
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  4. Hitoshi Kono
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  5. Yoshiomi Kobayashi
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  8. Takeshi Ikegami
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  10. Takahito Iga
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  11. Kazuki Takeda
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  16. Kota Watanabe
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Contributions

TO collected and interpreted the data and drafted the initial manuscript. NN and JY assisted with manuscript preparation. TO also designed the study, while HK, YK, TY, KK, TI, YH, TI, KT, MO, SS, MM, MN, and KW critically reviewed the manuscript. All authors approved the final version and share collective responsibility for all aspects of the work, ensuring that any questions regarding the study’s accuracy or integrity are thoroughly addressed and resolved.

Corresponding author

Correspondence to Narihito Nagoshi.

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Competing interests

The authors declare no competing interests.

Ethical approval

This study was conducted in accordance with the guidelines of the Declaration of Helsinki and was approved by the Ethics and Institutional Review Board of our institute (approval number: #20180045). Written informed consent was obtained from all participants prior to their inclusion in the study. We confirm that all relevant governmental and institutional regulations regarding the ethical use of human subjects were strictly followed throughout the study.

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Okubo, T., Nagoshi, N., Yamane, J. et al. Impact of surgeon experience on surgical outcomes after posterior decompression for degenerative cervical myelopathy: A prospective multicenter study. Spinal Cord (2026). https://doi.org/10.1038/s41393-026-01187-0

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