Epidemiology of Hospitalization and Surgical Therapy in Degenerative Cervical Myelopathy: A Nationwide 20-Year Analysis

Introduction : Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Despite its clinical importance, nationwide data on long-term incidence and surgical management trends in Germany remain scarce. Methods : A retrospective analysis was conducted using the German Federal Statistical Office’s hospital discharge database covering all inpatient cases with the primary diagnosis of DCM (ICD-10-GM code M50.0) from 2005 to 2024. Annual case numbers, age and sex distributions, and surgical procedures were analyzed descriptively. Hospitalization rates per 100,000 inhabitants were calculated using mid-year population data. Results : Between 2005 and 2024, approximately 70,000 hospitalizations for DCM were recorded nationwide. Annual cases increased from 2,477 (2005) to a peak of 4,076 (2015), followed by stabilization at ~3,000 cases/year thereafter. Hospitalization rates rose from 3.0 to 4.9 per 100,000 inhabitants over the same period. DCM predominantly affected men (53%) and individuals aged 50–70 years, with a progressive shift toward older age groups. Mean length of stay decreased steadily from 9–10 days in 2005 to 6–7 days in 2024. Anterior surgical approaches consistently represented most procedures. While posterior and combined approaches accounted for a smaller proportion, their use increased steadily over time. Normalized to annual hospitalizations, the proportion of surgically treated cases rose from ~65% (2005) to ~88% (2023), indicating increasingly selective inpatient admission for operative management. Conclusions : The burden of DCM in Germany rose substantially over the past two decades before stabilizing at a high level. Surgical treatment remains dominated by anterior decompression and fusion, while posterior procedures gain relevance in complex or multilevel disease. Shorter hospital stays and increasing surgical ratios reflect optimized perioperative pathways and more selective inpatient care. These results provide a comprehensive foundation for health-care planning and resource allocation in the management of DCM.