The effect of postoperative rehabilitation on outcomes in patients with degenerative cervical myelopathy (DCM): A systematic review

TL;DR

This review examines how post-surgery rehabilitation affects outcomes for patients with cervical spine issues, finding that combined approaches help most but more high-quality research is needed.

Contribution

The study systematically evaluates the impact of postoperative rehabilitation on DCM patients, highlighting the effectiveness of multimodal interventions.

Findings

Mixed rehabilitation interventions improve neurological function, quality of life, and self-efficacy.

Most studies had high risk of bias and lacked standardization.

Multimodal, goal-oriented rehabilitation shows the most consistent benefits.

Abstract

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.

What are the effects of postoperative rehabilitation on clinical outcomes following DCM surgery?

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.

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.

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.

•DCM postoperative rehabilitation effects were systematically reviewed.•Mixed, multimodal interventions showed the most consistent clinical benefits.•Improvements seen in neurological function, quality of life, and self-efficacy.•Evidence quality was limited by high risk of bias and study heterogeneity.•Standardized, high-quality RCTs are needed to guide postoperative DCM care.

DCM postoperative rehabilitation effects were systematically reviewed.

Mixed, multimodal interventions showed the most consistent clinical benefits.

Improvements seen in neurological function, quality of life, and self-efficacy.

Evidence quality was limited by high risk of bias and study heterogeneity.

Standardized, high-quality RCTs are needed to guide postoperative DCM care.

Figures