Introduction Cervical spondylotic myelopathy (CSM) surgery is frequently associated with residual neurological deficits, partly due to unrecognized dynamic spinal cord compression on conventional MRI. Current static imaging may miss position-dependent stenosis, resulting in insufficient or inappropriate decompression. This study aims to evaluate whether dynamic MRI-guided individualized surgery improves neurological outcomes compared to conventional MRI-based planning.

Objectives This study aims to examine the association between dynamic MRI-guided surgical planning and neurological recovery in cervical spondylotic myelopathy, and to evaluate its role in identifying responsible segments, avoiding excessive surgery, and improving clinical outcomes.

Methods This single-center retrospective cohort study will include 300 patients who underwent cervical spine surgery between January 2020 and December 2025 at the First Affiliated Hospital of Guangxi University of Chinese Medicine. Patients will be categorized into the dynamic MRI-guided group (n=150) or conventional MRI-based group (n=150) based on preoperative imaging modality. 1:1 propensity score matching will be performed using age, sex, BMI, disease duration, baseline mJOA score, and number of compressed segments. The primary outcome is the rate of improvement in the mJOA score at 6 months postoperatively. Secondary outcomes include VAS, NDI, reoperation rate, and time to first complication. Between-group comparisons will use t-tests/Mann-Whitney U tests for continuous variables, χ² tests/Fisher’s exact tests for categorical variables, and Kaplan-Meier estimates with the log-rank test for time-to-event outcomes. A two-sided P<0.05 will be considered significant. Analyses will be performed using R software (version 4.4.1). Ethical approval was obtained from the Medical Ethics Committee of the First Affiliated Hospital of Guangxi University of Chinese Medicine (Approval No. 2025-080-KY-01) from February 06, 2026 to February 05, 2027.

Expected outcomes We hypothesize that dynamic MRI-guided surgical planning will improve neurological recovery and decompression accuracy in cervical spondylotic myelopathy, providing evidence for optimized preoperative imaging and precision spine surgery.

Trial registration ChiCTR2600122088

The authors have declared no competing interest.

ChiCTR2600122088

The author(s) received no specific funding for this work.

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This study has been approved by the Medical Ethics Committee of the First Affiliated Hospital of Guangxi University of Chinese Medicine (Ethics Approval 2025-080-KY-01).

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