Influence of Preoperative Mental Health on Surgical and Clinical Outcomes in Degenerative Cervical Myelopathy: A Multicenter Prospective Cohort Study

Abstract

Study design: Multicenter prospective cohort study.

Objective: To evaluate the influence of preoperative mental health status on clinical outcomes following surgery for degenerative cervical myelopathy (DCM).

Summary of background data: Surgical treatment for DCM is known to improve neurological function and relieve symptoms. However, the impact of preoperative mental health on postoperative changes in pain, function, and quality of life (QOL) remains unclear.

Methods: A total of 759 patients who underwent surgery for DCM at 10 institutions were prospectively enrolled and stratified into two groups based on preoperative 36-Item Short-Form Health Survey (SF-36) Mental Component Summary (MCS) scores: Lower MCS (<50; n=339) and Higher MCS (≥50; n=420). Demographic, surgical, and radiographic data, along with clinical outcomes, were compared between groups. Outcome measures included the Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS), JOA Cervical Myelopathy Evaluation Questionnaire, SF-36, and Neuropathic Pain Symptom Inventory.

Results: Baseline demographics and surgical characteristics were similar; however, psychiatric disorders (4.7% vs. 1.2%, P=0.003) and diabetes (26.0% vs. 19.8%, P=0.042) were more prevalent in the Lower MCS group. Neurological recovery was comparable (ΔJOA: 3.0 vs. 2.9, P=0.948). However, the Lower MCS group demonstrated significantly greater improvement in neck pain (ΔVAS: -10.4 vs. -4.7, P=0.016), vitality (15.0 vs. 0.7, P<0.001), mental health (15.9 vs. 2.3, P<0.001), and burning pain (-0.5 vs. -0.3, P=0.014). Preoperative MCS was not associated with ΔJOA or recovery rate, but positively correlated with changes in SF-36 mental domains and negatively with burning pain.

Conclusions: Preoperative mental health status does not impact neurological improvement but significantly affects recovery in pain and QOL. These findings suggest that evaluating patients' psychological well-being before surgery could enhance perioperative planning and support more accurate prognostic counseling.

Level of evidence: II.

Keywords: SF-36; degenerative cervical myelopathy; mental health; neuropathic pain; patient-reported outcomes; prospective study; surgical outcomes.