Mental Health Recovery Trajectories After Surgery for Degenerative Cervical Myelopathy: A Canadian Spine Outcomes Research Network Study.

OBJECTIVE: To identify distinct postoperative trajectories of mental health following surgery for degenerative cervical myelopathy (DCM) and to assess the independent association between trajectory membership and 12-month patient satisfaction.

SUMMARY OF BACKGROUND DATA: Although surgery improves neurological and functional outcomes for patients with DCM, its impact on mental health remains poorly characterized. Patients with DCM frequently report poor mental well-being, which may influence quality of life and satisfaction with treatment.

METHODS: We analyzed data from the ongoing Canadian Spine Outcomes Research Network (CSORN) multicenter prospective observational DCM study. Group-based trajectory modeling (GBTM) was used to identify latent MCS recovery trajectories. Logistic regression evaluated associations between trajectory group membership and 12-month satisfaction, adjusting for demographic and clinical variables.

RESULTS: Among the 729 patients included, four distinct trajectories of mental health HRQoL recovery were identified based on longitudinal MCS scores: Low-stable (persistently low MCS [12%]), Moderate-stable (intermediate and unchanged MCS [36%]), Good-stable (high and stable MCS [38%]), and Improved (low baseline MCS with postoperative improvement [14%]). Pairwise comparisons showed that the Improved group achieved significantly greater gains in disability (NDI, P<0.001), neck pain (NRS neck, P=0.002), mental health HRQoL (MCS, P<0.001), and physical health (PCS, P=0.001) compared with the Low-stable group, while changes in neurologic function and arm pain did not differ. Trajectory group membership was associated with satisfaction: compared with Low-stable, Good-stable (OR 7.39, 95% CI 3.09-17.70) and Improved (OR 4.18, 95% CI 1.77-9.87) groups were significantly more likely to report being satisfied at 12 months.

CONCLUSION: Mental health HRQoL recovery following DCM surgery is heterogeneous, with only a minority of patients achieving substantial postoperative improvement. Whether routine assessment of mental-health HRQoL or targeted perioperative support alters outcomes is an area of research that warrants prospective study.

STUDY DESIGN: Retrospective analysis of a multicenter, prospective observational cohort.