Objectives To audit the waiting time for patients with degenerative cervical myelopathy (DCM ) and its impact on outcome in the Imperial College NHS Trust (ICNHST) against the latest AO standard.

Design Retrospective analysis.

Subjects 1. Waiting time for surgery and impact on outcome for DCM. 2. Operative approach.

Methods The medical records of 107 patients who had undergone surgery for DCM at ICNHST in 2016 to 2017 was reviewed. Central tendency analysis of nominal and ordinal variables such as surgery waiting time and demographics were assessed using Microsoft excel.

Results The mean age reviewed was 58.2 years. Male to female ratio was 1:1. The mean wait time was 10.22 overall. However, 58% of cases were moderate with mean wait time in that stratum at 4 weeks. Most patients improved at 3–6 months by 2 points on the mJOA regardless of approach done although 63% of cases were anterior. The results were compatible with the latest AO recommendations except for mild patients where it seemed more efficient to converse about morbidity of surgery vs myelopathy in the first instance, since disease burden is tolerable and plated in most hence risk may outweigh benefit. The approach chosen should be individually chosen based on a gestalt of patient and disease factors since results are equivocal.

Conclusions The approach to the cervical myelopathy must be taken at the merit of each patient based on a gestalt of the individual clinical factors involved. However, default approach to limiting wait to under 4 weeks is reasonable.