DELAYED SURGICAL TREATMENT FOR PATIENTS WITH DEGENERATIVE CERVICAL MYELOPATHY IS ASSOCIATED WITH INFERIOR OUTCOMES FOR DISABILITY AND HEALTH-RELATED QUALITY OF LIFE: A MULTICENTRE COHORT STUDY FROM THE CANADIAN SPINE OUTCOMES AND RESEARCH NETWORK

Surgery is the gold standard treatment for progressive or at least moderate degenerative cervical myelopathy (DCM); however, the impact of delayed surgical treatment on patient outcomes remains unknown. The aim of this study is to identify the factors associated with delays in surgical treatment of DCM and assess how these delays affect postoperative outcomes. This study analyzed patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) from 2015 to 2023. Patients with mild to severe DCM with one-year follow-up were included. During initial assessment, surgeons recorded symptom duration categorically with six choices, which was reduced to a binary variable using a 12-month threshold. Standard symptom duration was defined as less than 12 months, while Extended was 12 months or more prior to presentation. Differences between groups were analyzed using unadjusted bivariate analysis, and the associations between delayed surgical treatment on minimally clinically important differences (MCID) of PROMs were assessed using multivariable logistic regression analysis. A total of 483 patients (227 in the Standard group and 256 in the Extended) were included. At baseline, BMI (p Symptom duration < 1 2 months was significantly associated with higher odds of achieving MCID for the outcomes Neck Disability Index (OR=1.88, p < 0 .012), SF-12 PCS (OR=1.86, p < 0 .018) and EQ-5D (OR=1.92, p < 0 .011) at 12 months postoperatively. The odds of reaching the MCID for the mJOA did not significantly differ by symptom duration (OR=0.90, p < 0 .704). DCM patients with symptom duration of 12 months or more before surgery experienced inferior outcomes for disability and health-related quality of life compared to patients waiting less than 12 months, despite similar neurological outcomes. These results suggest that efforts to prioritize early diagnosis and timely surgery are warranted.