Pain and Paresthesia Patterns in Degenerative Cervical Myelopathy: Neuropathic Sensory Features and Postoperative Transitions in a Prospective Cohort

Spine J. 2026 Apr 13:S1529-9430(26)00117-8. doi: 10.1016/j.spinee.2026.04.016. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Pain and paresthesia are common in degenerative cervical myelopathy (DCM), yet their relationship and postoperative course remain uncertain.

PURPOSE: To categorize patients undergoing surgery for DCM using preoperative pain and paresthesia severity, characterize neuropathic sensory signatures, and quantify postoperative transitions among groups.

STUDY DESIGN/SETTING: Prospective cohort study at a single academic institution.

PATIENT SAMPLE: Of 408 eligible surgical DCM cases, 306 with complete preoperative and 1-year postoperative datasets were analyzed.

OUTCOME MEASURES: NRS for hand pain and hand paresthesia; EuroQol 5-Dimension (EQ-5D); the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ); Neuropathic Pain Symptom Inventory (NPSI); and painDETECT questionnaire (PDQ).

METHODS: Using an NRS threshold of 7 to define "high" symptoms, patients were classified as Group A (low pain/low paresthesia), Group B (low pain/high paresthesia), and Group C (high pain/high paresthesia). High pain/low paresthesia was rare (n=2, 0.6%) and excluded. Group differences were assessed using parametric/nonparametric tests with multiplicity-adjusted post hoc comparisons. Associations between NRS pain/paresthesia and NPSI items were assessed by Spearman correlation. Postoperative transitions were summarized using a transition matrix and tested for asymmetry.

RESULTS: Preoperatively, 159 (51.9%) patients were Group A, 85 (27.8%) Group B, and 60 (19.6%) Group C. Groups B and C had worse preoperative EQ-5D and JOACMEQ scores than Group A, whereas Groups B and C did not differ. At 1 year, EQ-5D and JOACMEQ improved and converged across preoperative groups, despite residual pain/paresthesia in a subset. Paresthesia NRS correlated most closely with NPSI tingling, whereas pain NRS showed higher scores across multiple NPSI domains. Groups B and C shared prominent tingling, but Group C showed broader NPSI elevation and higher PDQ scores. Postoperative transition analysis showed net movement toward Group A, with Group B reaching Group A more frequently than Group C.

CONCLUSIONS: We investigated pain-paresthesia patterns in DCM patients. Among patients with severe paresthesia, concomitant severe pain was associated with broader neuropathic sensory signatures. Although EQ-5D and JOACMEQ converged after surgery, the likelihood of reaching the low pain/low paresthesia state differed between groups.

PMID:41985691 | DOI:10.1016/j.spinee.2026.04.016