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Predictors of poor outcomes after posterior decompression surgery in patients with degenerative cervical myelopathy

Spinal Cord volume 63, pages 538–543 (2025)Cite this article

Subjects

Abstract

Study Design

Retrospective multicenter study.

Objectives

To identify predictors associated with failure of neurological improvement after posterior decompression surgery for degenerative cervical myelopathy (DCM).

Setting

17 institutions in Japan.

Methods

Patients who underwent posterior decompression surgery and were followed up for >1 year were enrolled. The Japanese Orthopedic Association (JOA) recovery rate was determined, and patients were divided into three outcome groups based on the JOA recovery rate: fair (recovery rate, <22.2%: mean-1SD), moderate (22.3%–77.1%), and good (>77.2%: mean+1 SD) groups. Demographic information, postoperative complications, and radiographic parameters were assessed, and predictors of poor outcomes were identified using the multinominal logistic regression analysis.

Results

Of 868 patients enrolled, 140 (16.1%), 586 (67.5%), and 142 (16.3%) were assigned to the fair, moderate, and good groups, respectively, with mean JOA recovery rates of 6.2% ± 13.7%, 50.1% ± 15.0%, and 90.6% ± 8.3%. Although there were significant differences in the frequency of diabetes mellitus among the three groups in the univariate analysis (26.4% vs. 23.0% vs. 14.1%; p = 0.03), the multinominal regression analysis revealed that old age was a significant independent predictor of poor outcomes in the comparison between the fair and good groups (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.27–2.07; p < 0.01). Old age was also significantly associated with failure of neurological improvement between the fair and moderate groups (OR, 1.35; 95% CI 1.15–1.59; p < 0.01).

Conclusions

Old age may be an independent predictor of failure of neurological improvement after posterior decompression surgery in patients with DCM.

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Fig. 1: The distribution of the JOA recovery rate.

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Data availability

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

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Acknowledgements

The authors would like to thank Dr Soraya Nishimura, Shusuke Matsuda, Kazuki Takeda, Yuichiro Mima and Ryutaro Tanaka for collection of data.

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

    Satoshi Suzuki, Narihito Nagoshi, Kota Watanabe, Masaya Nakamura & Morio Matsumoto

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

    Satoshi Suzuki, Narihito Nagoshi, Kanehiro Fujiyoshi, Ryoma Aoyama, Osahiko Tsuji, Eijiro Okada, Nobuyuki Fujita, Mitsuru Yagi, Takashi Tsuji, Kota Watanabe, Masaya Nakamura, Morio Matsumoto, Ken Ishii & Junichi Yamane

  3. Department of Orthopaedic Surgery, Murayama Medical Center, Tokyo, Japan

    Kanehiro Fujiyoshi

  4. Department of Orthopaedic Surgery, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan

    Ryoma Aoyama

  5. Deparment of Orthopaedic Surgery, Ohashi Hospital, Toho University, Tokyo, Japan

    Osahiko Tsuji

  6. Setagaya Okada Orthopaedic surgery Clinic, Tokyo, Japan

    Eijiro Okada

  7. Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan

    Nobuyuki Fujita

  8. Department of Orthopedic Surgery, School of Medicine International University of Health and Welfare, Chiba, Japan

    Mitsuru Yagi

  9. Department of Orthopaedic Surgery, Tokyo Medical Center, Tokyo, Japan

    Takashi Tsuji

  10. New Spine Clinic Tokyo, Tokyo, Japan

    Ken Ishii

  11. Department of Orthopaedic Surgery, Kanagawa Prefectural Police Association Keiyu Hospital, Kanagawa, Japan

    Junichi Yamane

Authors
  1. Satoshi Suzuki
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  2. Narihito Nagoshi
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Contributions

SS contributed to the data collection, data analysis, data interpretation and preparation of the initial draft of the manuscript. NN and JY contributed to the study design, data analysis, data interpretation, and assistance with manuscript preparation. KF, RA, OT, EO, NF, MY, TT, KW were responsible for the data collection and interpretation of the results. MN, MM, KI were responsible for the interpretation of the results, and supervision of the manuscript. All authors critically reviewed and approved the final version.

Corresponding authors

Correspondence to Narihito Nagoshi or Junichi Yamane.

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Competing interests

The authors declare no competing interests.

Ethical approval

This study was conducted following the tenets of the World Medical Association Declaration of Helsinki, and performed after approval from the Ethics and Institutional Review Board of Keio University School of Medicine (approval number: #20110142). All participants provided informed consent before surgery.

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Suzuki, S., Nagoshi, N., Fujiyoshi, K. et al. Predictors of poor outcomes after posterior decompression surgery in patients with degenerative cervical myelopathy. Spinal Cord 63, 538–543 (2025). https://doi.org/10.1038/s41393-025-01107-8

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