A Systematic Review and Meta-Analysis of Quantitative Pain Outcomes in Degenerative Thoracic Myelopathy

Abstract 55 Degenerative thoracic myelopathy (DTM) refers to symptomatic compression of the thoracic 56 spinal cord secondary to degenerative pathology, including thoracic disc herniation (TDH), 57 ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal 58 ligament (OPLL). Sensorimotor impairments and sphincter dysfunction often accompany 59 pain, yet quantitative characterisation of pain and pain-related functional disability outcomes 60 remains limited. We aimed to synthesise quantitative pain outcomes in DTM. The review was 61 registered with PROSPERO (CRD420261297878) and conducted following PRISMA 62 guidelines. MEDLINE and Embase were searched from inception until December 2025. 63 Screening and data extraction were performed in duplicate and all risk-of-bias scoring was 64 cross-checked. Findings were synthesised by random-effects meta-analyses for cohorts with 65 sufficient data to estimate the standard deviation of change in pain. Cohorts not included in 66 the meta-analysis were synthesised following the SWiM guidelines. Twenty-eight studies 67 comprising 1225 patients within 34 cohorts met inclusion criteria. Every cohort improved 68 after surgery (34/34 for the visual analogue scale (VAS); 10/10 for the Oswestry Disability 69 Index (ODI)). In the 19 VAS cohorts that could be weighted (578 patients), the pooled 70 reduction was 3.45 cm (95% CI 2.88-4.03; I² = 94.5%), and in the nine ODI cohorts that 71 could be weighted (145 patients) the pooled reduction was 29.4 points (20.9-37.8; I² = 72 97.3%). The pooled VAS reduction was 4.06 cm in TDH and 3.34 cm in OLF cohorts. The 73 ten VAS cohorts that could not be weighted (436 patients) were synthesised descriptively, 74 with a median of the reported mean reductions of 4.28 cm (IQR 3.85-4.63). Similar 75 reductions were reported for discectomy with and without fusion. Only six studies reported 76 axial pain separately from non-axial pain; consistent differentiation of pain subtypes and 77 standardised reporting of pain measures are needed to strengthen the evidence base. Surgery 78 for DTM appears to be associated with reductions in pain and pain-related functional 79 disability, although substantial heterogeneity and the uncontrolled design of studies mean that 80 certainty of the evidence is currently very low.