Introduction

Surgical intervention for cervical spondylotic myelopathy (CSM) primarily aims to halt neurological decline and alleviate debilitating symptoms. While many patients experience significant relief, a subset continues to struggle with persistent arm pain post-CSM surgery. Understanding the long-term trajectory of this pain is essential for setting realistic patient expectations and optimizing postoperative care. A recent multi-center analysis from the Spine CORe™ group, utilizing Quality Outcomes Database (QOD) data, provides valuable insights into the factors influencing pain persistence five years after the procedure.

Researchers evaluated 1,085 patients undergoing surgery for CSM across 14 study sites. Specifically, they focused on 458 individuals who presented with severe preoperative arm pain, defined by a numeric rating scale (NRS) score of 7 to 10. The study tracked NRS scores at multiple intervals, including three months, one year, and five years post-surgery. Furthermore, the team assessed various patient-reported outcome measures, such as the Neck Disability Index (NDI) and modified Japanese Orthopaedic Association (mJOA) scale.

Identifying Risk Factors for Persistent Arm Pain Post-CSM Surgery

The results of the five-year follow-up reveal a varied recovery landscape. Approximately 60.7% of patients reported mild arm pain, while 20.4% experienced moderate symptoms. However, 18.9% of the cohort continued to suffer from persistent severe arm pain five years after their operation. This persistent pain group demonstrated significantly higher NDI scores compared to those who improved. Additionally, these patients had lower functional scores on the mJOA scale and reduced Quality-Adjusted Life Years (QALY).

Consequently, the study suggests that certain functional and quality-of-life metrics are strong indicators of long-term pain outcomes. The correlation between persistent pain and lower EuroQol visual analog scale (EQ-VAS) scores highlights the broader impact on a patient's overall health perception. Clinicians should closely monitor NDI and mJOA scores, as these functional measures often mirror the patient's actual pain experience. In addition, addressing residual disability early in the postoperative period might help improve long-term satisfaction for patients in India and globally.

Conclusion

While surgery effectively manages CSM for the majority, nearly one in five patients may face long-term severe arm pain. Surgeons must utilize preoperative and early postoperative functional scores to identify high-risk individuals. By recognizing these risk factors, medical professionals can tailor rehabilitation strategies and manage expectations more effectively. Ultimately, longitudinal data from the QOD underscores the importance of holistic patient assessment beyond simple pain scales.

Frequently Asked Questions

How common is severe arm pain five years after CSM surgery?

According to the QOD analysis, approximately 18.9% of patients who had severe arm pain before surgery still reported severe pain five years postoperatively.

Which functional scores correlate with persistent postoperative pain?

Patients with persistent severe arm pain typically show significantly higher Neck Disability Index (NDI) scores and lower modified Japanese Orthopaedic Association (mJOA) scores.

Does surgery for CSM improve quality of life even if pain persists?

While surgery generally improves Quality-Adjusted Life Years (QALY), those with persistent severe pain tend to have significantly lower QALY and EQ-VAS scores compared to patients with improved pain levels.

Disclaimer: This content is for informational and educational purposes only and does not constitute medical advice. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

1. Kharas N et al. Risk factors for persistent arm pain 5 years after surgery for cervical spondylotic myelopathy: a Spine CORe™ analysis of QOD data. Neurosurg Focus. 2026 May 01. doi: 10.3171/2025.12.FOCUS25935. PMID: 42066365.


2. Nair AP, Abraham TR, Erubothu A. Factors affecting surgical outcomes in cervical spondylotic myelopathy: Age, symptom duration, preoperative disability, canal diameter, and intramedullary MRI changes are key prognostic indicators. Int Surg J. 2025.


3. Chan AK et al. What predicts the best 24-month outcomes following surgery for cervical spondylotic myelopathy? A QOD prospective registry study. J Neurosurg Spine. 2024;40(4):441-452.