Introduction: Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord impairment. Prompt surgical intervention halts clinical deterioration and results in clinical improvement in most patients; however, in a public healthcare system, wait-times to see a spine specialist and eventually access surgical treatment may be substantial. The goals of this study were to assess the consultation wait time (CWT) and the surgical wait time (SWT), as well as to identify predictors of wait time length in this population.
Methods: Consecutive patients enrolled in the CSORN prospective, observational CSM study from March 2015 to July 2017 were included. Predictors of CWT and SWT were assessed using survival analysis. Results were stratified by disease severity based on the mJOA. A data-splitting technique was used to develop and test the multivariable models looking at potential predictive factors.
Results: CSORN query returned 264 CSM patients for CWT (88 female and 176 male). Mean age was 59.4 y. The median CWT was 46 days. There were 31% mild, 35/% moderate and 33% severe CSM. There was a statistically significant difference in median CWT between moderate and severe groups. There were 207 patients who underwent surgical treatment. Median SWT was 42 days. There was a statistically significant difference between mild/moderate and severe groups. Short symptom duration, less pain, radiologic cord compression, lower BMI and lower PCS scores were predictive of shorter CWT. On the other hand, SWT was mainly affected by pain and symptom duration. Both CWT and SWT were shorter for CSM patients compared to lumbar stenosis patients (P< 0.001).
Conclusions: CSM patients with more severe symptoms had a shorter CWT and SWT. Patients with short symptom duration, less pain and spinal cord compression waited less to see a spine specialist in Canada. Patients with less pain and symptom duration less than a year had shorter SWT.
Patient Care: It will provide epidemiologic data on wait time for Consultation and Surgical treatment for CSM and also provides some predictors for each arm which can help the family physicians and Spine surgeons for sending a referral and managing referals in timely fashion
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of timely treatment of CSM, 2) Discuss the predictors of Consultation and Surgical wait time