{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T09:04:46Z","timestamp":1780131886516,"version":"3.54.0"},"reference-count":122,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Insurance status is known to influence access to spine surgery, but its role in cervical spondylotic myelopathy (CSM) remains underexplored. The authors hypothesized that government insurance payor status would be associated with delayed care access, evidenced by prolonged symptom duration and greater baseline symptom severity relative to those with private insurance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This was a prospective observational cohort study of 1085 patients enrolled in the Quality Outcomes Database CSM module of the 14-site Spine CORe\u2122 study group. Patients were included if they had complete data for insurance, symptom duration, and baseline patient-reported outcomes (PROs). Insurance status was categorized as private, Medicare, Medicaid, or Veterans Affairs (VA)\/federal. Primary outcomes included surrogates of access to care, assessed by symptom duration (&gt; 12 months) and baseline PROs, i.e., the Neck Disability Index (NDI) and EQ-5D. Associations were evaluated using multivariable logistic regression analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 1085 patients with CSM who underwent surgery were enrolled, with more than 80% completing 5-year follow-up. Patients were excluded if they were uninsured or did not report baseline symptom duration, EQ-5D score, or NDI score, leaving a cohort of 977 patients for analysis. The proportion of patients reporting symptom duration &gt; 12 months differed by insurance status (p &lt; 0.001): highest in VA\/federal (18\/24, 75%), followed by Medicaid (45\/70, 64%), Medicare (206\/375, 55%), and private insurance (228\/508, 45%).<\/jats:p>\n                    <jats:p>Compared to those who had private insurance, patients covered by VA\/federal insurance (OR 3.85, 95% CI 1.56\u201310.89), Medicaid (OR 2.05, 95% CI 1.18\u20133.61), and Medicare (OR 1.98, 95% CI 1.39\u20132.82) had symptom duration &gt; 12 months. Of patients with government insurance payors, Medicaid insurance status was independently associated with worse baseline disability (NDI: \u03b2 = 7.35, 95% CI 2.35\u201312.35; p = 0.004) and lower quality of life (EQ-5D: \u03b2 = \u22120.12, 95% CI \u22120.18 to \u22120.07; p &lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Compared to patients with private insurance, patients covered by government insurance payors (VA\/federal insurance, Medicare, and Medicaid) had significantly longer symptom duration before undergoing surgery. Patients with VA\/federal insurance coverage had the longest symptom duration of the government payors. Of the government insurance payor types, Medicaid was the only one independently associated with significantly worse baseline disability (NDI) and quality of life (EQ-5D). After controlling for other factors, patients with government insurance coverage, and more specifically Medicaid, have difficulty accessing surgical care in a timely fashion to treat CSM compared to patients with private insurance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.12.focus25951","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T11:31:12Z","timestamp":1777635072000},"page":"E9","source":"Crossref","is-referenced-by-count":0,"title":["Do patients with government insurance payors experience delayed access to surgical care for cervical spondylotic myelopathy? A Spine CORe\u2122 analysis of QOD data"],"prefix":"10.3171","volume":"60","author":[{"given":"Abraham","family":"Dada","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niall","family":"Buckley","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satvir","family":"Saggi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"DiGiorgio","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheerag D.","family":"Upadhyaya","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica F.","family":"Bisson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Bydon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony L.","family":"Asher","sequence":"additional","affiliation":[{"name":"Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul K.","family":"Kim","sequence":"additional","affiliation":[{"name":"Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric A.","family":"Potts","sequence":"additional","affiliation":[{"name":"Goodman Campbell Brain and Spine, Indianapolis, Indiana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent J.","family":"Alentado","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin T.","family":"Foley","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Y.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Miami, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai-Ming","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Weill Cornell Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Virk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Weill Cornell Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oren N.","family":"Gottfried","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J.","family":"Knightly","sequence":"additional","affiliation":[{"name":"Atlantic Neurosurgical Specialists, Morristown, New Jersey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Meyer","sequence":"additional","affiliation":[{"name":"Atlantic Neurosurgical Specialists, Morristown, New Jersey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Po","family":"Yen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew K.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis M.","family":"Tumial\u00e1n","sequence":"additional","affiliation":[{"name":"Barrow Neurological Institute, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan S.","family":"Uribe","sequence":"additional","affiliation":[{"name":"Barrow Neurological Institute, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay D.","family":"Turner","sequence":"additional","affiliation":[{"name":"Barrow Neurological Institute, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy J.","family":"Yee","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Michigan, Ann Arbor, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regis W.","family":"Haid","sequence":"additional","affiliation":[{"name":"Atlanta Brain and Spine Care, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen V.","family":"Mummaneni","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University 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