The Effect of Postoperative Rehabilitation on Outcomes in Patients With Degenerative Cervical Myelopathy (DCM): A Systematic Review

Abstract

Introduction: Degenerative cervical myelopathy (DCM) is the leading cause of adult spinal cord dysfunction, often requiring surgery. However, the role of postoperative rehabilitation in optimizing patient outcomes remains unclear. Research question: What are the effects of postoperative rehabilitation on clinical outcomes following DCM surgery?

Material and methods: This systematic review was registered with PROSPERO (CRD42024582484). PubMed, Scopus, and Web of Science were searched through September 2025. Eligible studies included randomized controlled trials (RCTs), and other research on rehabilitation interventions for postoperative outcomes (e.g., function, pain, neurological recovery) in patients undergoing DCM surgery. Studies without confirmed DCM, non-peer-reviewed articles, or lacking a rehabilitation protocol were excluded. Risk of bias was assessed using the RoB 2 and ROBINS-I. Descriptive summaries were conducted, categorizing studies into active, passive, and mixed interventions. The evidence quality was rated using the GRADE approach.

Results: Ten studies with a total of 766 patients were included, made up of 5 RCTs and 5 cohort studies. Seven studies had high risk of bias, and three had moderate risk of bias. Mixed rehabilitation interventions combining physical, behavioral, and psychosocial strategies yielded the most consistent improvements in neurological function, quality of life, and self-efficacy. Intervention timing ranged from a few days postoperatively to 6 months. A meta-analysis was not performed due to study heterogeneity.

Discussion and Conclusion: Postoperative rehabilitation for DCM shows promise, particularly with multimodal, goal-oriented, and patient-centered approaches. However, evidence is limited by the high risk of bias, poor methodological detail and lack of standardization.