Identification, validation, and prediction of longitudinal recovery phenotypes in degenerative cervical myelopathy: analysis of prospective cohorts and a randomised controlled trial
EClinicalMedicine · 22 Aug 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
This challenges the traditional practice of tracking DCM recovery by neurologic score alone and suggests surgeons should also monitor neck pain/disability and quality-of-life trajectories to counsel patients about expected recovery patterns.
The evidence
This study pooled three prospective DCM cohorts (1047 patients treated surgically) and used a statistical clustering method to look for patterns in how neurological function (mJOA), neck disability (NDI), and physical quality of life (SF-36 PCS) changed together over the first postoperative year. Three trajectories emerged: minimal responders (17%, little improvement), neck-pain responders (50%, big NDI gains but modest neurologic gains), and global responders (33%, improvement across all domains); global responders had far higher odds of reaching a clinically important improvement in mJOA (OR 10.90, 95% CI 6.15-19.32) compared with minimal responders.
Achievement of MCID in mJOA at one year: Odds ratio 10.9 (95% CI 6.15 to 19.32; mJOA). Interpret in the study's stated comparison; this alone does not establish a treatment's causal effect.
Why this rigour score?
Retrospective case seriesDesign starting point: 8.8
Raised the score
No positive adjustments recorded.
Lowered the score
No negative adjustments recorded.
Methods at a glance
Recorded assessment- Confounding adjustmentMultivariable regression
- Covariate balance confirmedNot applicable
- Outcome assessors blindedNot reported
- Comparable start of follow-upNot applicable
- Adequate statistical powerNot applicable
- Prospective registrationNot met
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 8.8
- Journal prior (not an observed method)
- +0.6
- Final rigour score rounded
- 9 / 100
Study design sets the starting point and a ceiling of 42. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.If a patient's baseline profile predicts they are likely to be a 'neck pain responder' with only modest neurological gain, how should that change preoperative counselling about expected outcomes?
2.Should surgical approach (anterior vs posterior) be chosen partly based on its association with different recovery phenotypes, or is this association too confounded by baseline disease severity to act on?
Original publication title
Identification, validation, and prediction of longitudinal recovery phenotypes in degenerative cervical myelopathy: analysis of prospective cohorts and a randomised controlled trial