Surgery for Degenerative Thoracic Myelopathy Reduces Pain, Review Finds

Surgery for degenerative thoracic myelopathy, a condition in which the thoracic spinal cord is compressed by degenerative changes in the spine, is associated with substantial reductions in pain and pain-related disability, according to a systematic review and meta-analysis published in Frontiers in Neuroscience. The review, registered with PROSPERO and conducted according to PRISMA guidelines, pooled quantitative pain outcomes from 28 studies covering 1,225 patients across 34 cohorts, and found that every included cohort improved after surgery.

Degenerative thoracic myelopathy arises when symptomatic compression of the thoracic spinal cord is caused by degenerative pathology, including thoracic disc herniation, ossification of the ligamentum flavum, and ossification of the posterior longitudinal ligament. While sensorimotor impairments and sphincter dysfunction often accompany the condition, pain is a common and disabling feature, yet the authors note that quantitative characterisation of pain and pain-related functional disability outcomes has remained limited.

The researchers searched MEDLINE and Embase 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 using random-effects meta-analyses for cohorts with sufficient data to estimate the standard deviation of change in pain, while cohorts that could not be included in the meta-analysis were synthesised descriptively following the SWiM guidelines.

For pain measured on the visual analogue scale, all 34 cohorts improved after surgery. In the 19 VAS cohorts that could be weighted, covering 578 patients, the pooled reduction was 3.45 cm on the 10 cm scale, with a 95% confidence interval of 2.88 to 4.03 cm. The heterogeneity across studies was very high, with an I² statistic of 94.5%, indicating that the pooled estimate masks considerable variation between cohorts.

For pain-related functional disability, all 10 cohorts that reported the Oswestry Disability Index improved. In the nine ODI cohorts that could be weighted, comprising 145 patients, the pooled reduction was 29.4 points, with a 95% confidence interval of 20.9 to 37.8 points. Heterogeneity was again very high, at I² = 97.3%. The remaining 10 VAS cohorts, covering 436 patients, could not be weighted and were synthesised descriptively; the median of their reported mean reductions was 4.28 cm, with an interquartile range of 3.85 to 4.63 cm.

The pooled VAS reduction differed by underlying pathology, reaching 4.06 cm in cohorts with thoracic disc herniation and 3.34 cm in cohorts with ossification of the ligamentum flavum. The review also found that similar reductions were reported for discectomy performed with and without fusion, suggesting that the choice between these surgical approaches was not associated with clearly different pain outcomes in the available data.

The authors highlight an important gap in the evidence base: only six studies reported axial pain separately from non-axial pain. They call for consistent differentiation of pain subtypes and standardised reporting of pain measures to strengthen future research, since the current literature does not allow a detailed picture of which types of pain respond to surgery.

The review’s conclusion is deliberately cautious. Surgery for degenerative thoracic myelopathy appears to be associated with reductions in pain and pain-related functional disability, but substantial heterogeneity between studies and the uncontrolled design of the included research mean that the certainty of the evidence is currently very low. Without control groups, the observed improvements cannot be definitively attributed to the surgical intervention itself, and the very high heterogeneity statistics reflect wide variation in study populations, interventions and outcome reporting.

Subject of Research: Quantitative pain outcomes after surgery for degenerative thoracic myelopathy

Article Title: A systematic review and meta-analysis of quantitative pain outcomes in degenerative thoracic myelopathy

Article References: Li, Z., Lee, P., Rujeedawa, T., Richmond, H. L., Jagodzinska, N., Toumbas, G., Davies, B. M., Kotter, M. R., & Mowforth, O. D. (2026). A systematic review and meta-analysis of quantitative pain outcomes in degenerative thoracic myelopathy. Frontiers in Neuroscience, 20, Article 1937393. https://doi.org/10.3389/fnins.2026.1937393

Image Credits: AI Generated

DOI: 10.3389/fnins.2026.1937393

Keywords: degenerative thoracic myelopathy, thoracic disc herniation, ossification of the ligamentum flavum, ossification of the posterior longitudinal ligament, visual analogue scale, Oswestry Disability Index, meta-analysis, systematic review, spinal surgery, pain outcomes, PROSPERO, PRISMA