Clinical Outcomes of Decompressive Spine Surgery for Painless Cervical Myelopathy

Neurosurgery 98:161–173, 2026

This multicenter retrospective study analyzes 407 patients from the Michigan Spine Surgery Improvement Collaborative who underwent decompressive surgery for cervical spondylotic myelopathy presenting without neck or arm pain. Patient-reported outcomes (mJOA, PROMIS PF, EQ-5D) and clinical endpoints were assessed at baseline, 90 days, 1 year, and 2 years to quantify functional and quality-of-life changes after surgery.

Results show modest but clinically meaningful improvements in function and quality of life for a subset of patients, with peak MCID rates at one year and sustained patient satisfaction above 80% at two years. Severe preoperative myelopathy predicted worse immediate disposition and higher readmission, although some severe cases still achieved early functional gains.

Painless Cervical Myelopathy (CSM) Surgery: Decompressive spine surgery in patients with CSM but without neck or arm pain led to clinically significant improvements in myelopathic symptoms and physical function for a modest proportion of patients.

Quality of Life Gains: Surgery resulted in increased quality of life, with mean EQ-5D scores higher at all postoperative time points compared to baseline, and over 80% of patients reported sustained satisfaction up to two years after surgery.

Severity-Dependent Outcomes: Patients with severe myelopathy had worse immediate surgical outcomes (lower rates of discharge to home, higher 90-day readmission) and lower quality of life at two years compared to those with mild myelopathy.

Incidence of Postoperative Pain: Despite presenting without pain, 20% of patients developed persistent postoperative neck pain and 14% developed arm pain at two years, rates comparable to those seen in typical CSM surgery cohorts.

Functional Improvement Metrics: At one year, 49% achieved clinically meaningful improvement in physical function (PROMIS PF), 36% in mJOA, and 42% in quality of life (EQ-5D); these improvements were most pronounced at one year and declined by two years for some metrics.

Surgical Approach Differences: Anterior approaches were associated with higher postoperative satisfaction and lower rates of complications like dysphagia compared to posterior or combined approaches.

Study Limitations: Limitations include lack of radiological data, possible misclassification of myelopathy severity, and significant loss to follow-up, affecting long-term outcome interpretation.

Clinical Implication: Surgery may halt progression and provide functional and quality of life benefits even in painless CSM, but patient selection remains challenging and further objective, randomized studies are needed.