Timing of Rehabilitation Following Cervical Spinal Surgery in Degenerative Myelopathy

The goal of this clinical trial is to learn whether starting rehabilitation earlier after surgery can improve recovery and is feasible and acceptable for adults with degenerative cervical myelopathy (DCM) undergoing cervical spine surgery. The main question it aims to answer is: Does starting rehabilitation earlier improve walking, balance, physical activity, quality of life, and nervous system function after surgery? Researchers will compare participants who begin rehabilitation two weeks after surgery with participants who begin rehabilitation six weeks after surgery to see if earlier rehabilitation leads to better recovery outcomes and participation. Participants will: Be randomly assigned to begin rehabilitation either two weeks or six weeks after surgery. Attend physical therapy sessions twice per week for eight weeks focused on strength, balance, and walking. Complete assessments of walking ability, balance, physical activity, quality of life, and nervous system function over several months after surgery. Provide feedback about their experience with the rehabilitation program, including satisfaction and any side effects or challenges related to participation.

Inclusion Criteria: * adult (\>18 years of age) with diagnosis of degenerative cervical myelopathy, within 2 weeks of spinal decompression surgery * plan to be discharged home from acute care (i.e., not admitted to another facility for post-operative rehabilitation) * able to stand with a maximum of one-person assist (+/- use of gait aid) * persistent functional impairment in lower extremity strength, balance, coordination, and/or gait * ability to attend an 8-week in-person rehabilitation program in Edmonton, Alberta Exclusion Criteria: * discharge from acute care facility \> 2 weeks post-operative * intra-operative or early post-operative complication delaying discharge or precluding participation in early rehabilitation