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

Abstract

Degenerative 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. The 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. Twenty-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; I 2  = 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; I 2  = 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. Surgery 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. PROSPERO , CRD420261297878.