Grant: Travel Awards - Institute Community Support

Degenerative cervical myelopathy (DCM) is a condition where age-related changes in the neck compress the spinal cord, causing problems with hand function, walking, balance, pain, and overall quality of life. Patients with "mild" disease are challenging to treat because their symptoms vary widely. Some improve with surgery, while others experience little benefit. Current tools used in clinical practice often group all mild patients together, making it difficult for surgeons and patients to know who is most likely to benefit from surgery. In this study, we analyzed data from 317 adults with mild DCM treated across 11 Canadian centers. Using a statistical method called latent profile analysis, we identified three meaningful subgroups based on patients' baseline pain, disability, and physical health, rather than relying only on their functional impairment score. The three groups were: (1) a mild-impairment group with low pain and disability, (2) a pain- and disability-dominant group with severe symptoms, and (3) a moderately impaired group with intermediate symptoms. We found that patients in the higher-symptom groups (Classes 2 and 3) were more likely to undergo surgery and were also more likely to experience meaningful improvements in pain, disability, and physical health after the operation. In contrast, patients with very mild symptoms (Class 1) showed smaller improvements because they were already functioning near normal levels before surgery. Importantly, these subgroup differences were not captured by the standard clinical scale, which failed to distinguish which mild patients would benefit most from surgery. Overall, our findings show that mild DCM is not a single uniform condition. By using multidimensional patient-reported measures, clinicians can better identify which patients are most likely to benefit from surgical treatment. This approach may improve personalized decision-making and help patients better understand what outcomes to expect from surgery.