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Surgery for degenerative thoracic myelopathy is associated with significant reductions in pain and disabilitySurgery for Thoracic Myelopathy Linked to Reduced Pain Levels

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Key Takeaway
Surgery for DTM is associated with reduced pain and disability, but evidence certainty is very low.

This systematic review and meta-analysis evaluated 34 cohorts involving 1,225 patients to assess the impact of surgery for degenerative thoracic myelopathy (DTM). The analysis focused on quantitative pain outcomes and the Oswestry Disability Index (ODI) as a measure of functional disability. The study included patients with conditions such as thoracic disc herniation and ossification of the ligamentum flavum.

The meta-analysis reported a pooled reduction of 3.45 cm in Visual Analogue Scale (VAS) scores (95% CI 2.88-4.03) and a pooled reduction of 29.4 points in ODI (20.9-37.8). Specific cohorts showed VAS reductions of 4.06 cm for thoracic disc herniation and 3.34 cm for ossification of the ligamentum flavum. Non-weighted cohorts showed a median reduction of 4.28 cm in mean VAS scores (IQR 3.85-4.63).

Several limitations were noted, including substantial heterogeneity (I2 values of 94.5% and 97.3%), uncontrolled study designs, and a lack of standardized reporting for pain measures. Because of these factors, the certainty of evidence is very low. While surgery for DTM is associated with improvements in pain and functional disability, the clinical certainty of these findings is limited by the underlying study designs and lack of differentiation between pain subtypes.

A large review of 34 different studies looked at the impact of surgery on 1,225 patients with degenerative thoracic myelopathy. This condition involves issues like disc herniation or the hardening of ligaments in the middle of the spine. The researchers looked specifically at how surgery affected pain levels and the ability of patients to perform daily activities.

The data showed that patients who underwent surgery experienced a reduction in pain scores. Specifically, the analysis found a pooled reduction of 3.45 points on a standard pain scale. There was also a notable decrease in scores on the Oswestry Disability Index, which measures how much pain limits a person's daily life. These results were seen across various types of spinal issues, including disc herniation and ligament issues.

It is important to note that the evidence for these findings is considered very low. The studies included were not all controlled, and there was a lot of variation between the different groups. Because of these factors, the results should be viewed as a link rather than a guarantee. Patients should talk to their doctors to determine the best treatment plan for their specific condition.

What this means for you:
Surgery for thoracic myelopathy is linked to lower pain, but the evidence is currently of very low certainty.

Common questions

Does surgery help with pain for thoracic myelopathy?

The study found that surgery for degenerative thoracic myelopathy was associated with a reduction in pain scores. Specifically, the data showed a pooled reduction of 3.45 on the visual analogue scale. However, because the study design was uncontrolled and had high variation, the certainty of this evidence is very low.

How does surgery affect daily activities for these patients?

The study found that surgery was linked to a reduction of 29.4 points on the Oswestry Disability Index. This scale measures how much pain impacts a person's daily life. While the results show a link to better function, the overall certainty of the evidence is low due to the variety of studies included.

What are the limitations of this finding?

The evidence is considered very low because the studies were not all controlled and had a lot of differences between them. There was also a lack of standardized reporting for pain measures and limited information on specific pain types. You should consult your doctor to discuss how these findings apply to your specific case.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
IntroductionDegenerative thoracic myelopathy (DTM) refers to symptomatic compression of the thoracic spinal cord secondary to degenerative pathology, including thoracic disc herniation (TDH), ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL). Sensorimotor impairments and sphincter dysfunction often accompany pain, yet quantitative characterisation of pain and pain-related functional disability outcomes remains limited. We aimed to synthesise quantitative pain outcomes in DTM.MethodsThe review was registered with PROSPERO (CRD420261297878) and conducted following PRISMA guidelines. MEDLINE and Embase were searched from inception until December 2025. Screening and data extraction were performed in duplicate and all risk-of-bias scoring was cross-checked. Findings were synthesised by random-effects meta-analyses for cohorts with sufficient data to estimate the standard deviation of change in pain. Cohorts not included in the meta-analysis were synthesised following the SWiM guidelines.ResultsTwenty-eight studies comprising 1,225 patients within 34 cohorts met inclusion criteria. Every cohort improved after surgery (34/34 for the visual analogue scale (VAS); 10/10 for the Oswestry Disability Index (ODI)). In the 19 VAS cohorts that could be weighted (578 patients), the pooled reduction was 3.45 cm (95% CI 2.88–4.03; I2 = 94.5%), and in the nine ODI cohorts that could be weighted (145 patients) the pooled reduction was 29.4 points (20.9–37.8; I2 = 97.3%). The pooled VAS reduction was 4.06 cm in TDH and 3.34 cm in OLF cohorts. The 10 VAS cohorts that could not be weighted (436 patients) were synthesised descriptively, with a median of the reported mean reductions of 4.28 cm (IQR 3.85–4.63). Similar reductions were reported for discectomy with and without fusion. Only six studies reported axial pain separately from non-axial pain; consistent differentiation of pain subtypes and standardised reporting of pain measures are needed to strengthen the evidence base.ConclusionSurgery for DTM appears to be associated with reductions in pain and pain-related functional disability, although substantial heterogeneity and the uncontrolled design of studies mean that certainty of the evidence is currently very low.Systematic review registrationPROSPERO, CRD420261297878.
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