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Can J Neurol Sci. 2019 Jul;46(4):430-435. doi: 10.1017/cjn.2019.34. Epub 2019 May 3.

Consultation and Surgical Wait Times in Cervical Spondylotic Myelopathy.

Author information

1
Division of Spine Surgery, University of British Columbia,Vancouver, British Columbia,Canada.
2
Canadian Spine Outcomes and Research Network,Toronto, Ontario,Canada.
3
Division of Spine Surgery,University of British Columbia and Vancouver General Hospital,Vancouver, British Columbia,Canada.
4
Department of Clinical Neurosciences,University of Calgary,Calgary, Alberta,Canada.
5
Winnipeg Spine Program Health Sciences Centre,University of Manitoba,Winnipeg, Manitoba,Canada.
6
Division of Orthopaedics, Department of Surgery, Schulich School of Medicine,Western University,London, Ontario,Canada.
7
Department of Surgery (Neurosurgery),Dalhousie University,Halifax, Nova Scotia,Canada.
8
Division of Spine, Department of Orthopaedics, The Combined Neurosurgical and Orthopaedic Spine Program,Vancouver Coastal Health,Vancouver, British Columbia,Canada.
9
Division of Neurosurgery, Department of Surgery,CHU de Québec-Université Laval,Québec City, Quebec,Canada.
10
Division of Neurosurgery, Department of Surgery,University of Alberta,Edmonton, Alberta,Canada.
11
Departments of Clinical Neurosciences and Radiology,University of Calgary Spine Program,Calgary, Alberta,Canada.
12
Department of Surgery, Canada East Spine and Dalhousie University,Saint John, New Brunswick,Canada.
13
Department of Surgery,University of Toronto,Toronto, Ontario,Canada.
14
Department of Surgery,University of Calgary,Calgary, Alberta,Canada.
15
Arthritis Program, Krembil Research Institute,University Health Network,Toronto, Ontario,Canada.
16
Combined Neurosurgery and Orthopaedic Spine Program,University of British Columbia,Vancouver, British Columbia,Canada.

Abstract

BACKGROUND:

Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord impairment. In a public healthcare system, wait times to see spine specialists and eventually access surgical treatment for CSM can be substantial. The goals of this study were to determine consultation wait times (CWT) and surgical wait times (SWT), and identify predictors of wait time length.

METHODS:

Consecutive patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) prospective and observational CSM study from March 2015 to July 2017 were included. A data-splitting technique was used to develop and internally validate multivariable models of potential predictors.

RESULTS:

A CSORN query returned 264 CSM patients for CWT. The median 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; 207 patients underwent surgical treatment. Median SWT was 42 days. There was a statistically significant difference in SWT between mild/moderate and severe groups. Short symptom duration, less pain, lower BMI, and lower physical component score of SF-12 were predictive of shorter CWT. Only baseline pain and medication duration were predictive of SWT. Both CWT and SWT were shorter compared to a concurrent cohort of lumbar stenosis patients (p <0.001).

CONCLUSIONS:

Patients with shorter duration (either symptoms or medication) and less neck pain waited less to see a spine specialist in Canada and to undergo surgical treatment. This study highlights some of the obstacles to overcome in expedited care for this patient population.

KEYWORDS:

Cervical; Myelopathy; Prediction; Wait times

PMID:
31046861
DOI:
10.1017/cjn.2019.34

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