BackgroundEvidence for managing chronic low back pain suggests beginning with non-invasive treatments and having surgery as a last resort. Currently, no studies examine treatment engagement for back pain in the six-months preceding elective spine surgery assessment. ObjectivesThis study aims to: 1) determine the engagement in non-pharmacological, non-operative treatment before elective thoracolumbar spine surgery (ETSS) assessment in XXXXXXXX; and 2) investigate potential factors associated with engagement in this population. DesignRetrospective cohort design. MethodsCanadian Spine Outcomes Research Network (CSORN) registry data were analyzed to compare groups who reported minimal engagement in non-pharmacological, non-operative treatment before ETSS assessment to those who engaged. Binary logistic regression was used to identify factors associated with engagement. ResultsA total of 144 patients qualified, 41.7% reported minimal engagement with non-pharmacological, non-operative treatment in the six-months preceding ETSS assessment. Four statistically significant factors associated with minimal engagement were identified: 1) 61–90 years of age (odds ratio [OR] 4.6, 95% confidence interval [CI] 2.0–10.7, p < .001); 2) Oswestry disability index (ODI) score >60% (OR 3.5, 95% CI 1.4–9.2, p = .010; 3) body mass index (BMI) score 25–29.9 (OR 6.7, 95% CI 2.2–20.9, p < .001) and BMI ≥ 30 (OR 4.2, 95% CI 1.4–12.2, p = .009); and 4) female biological sex (OR 2.4, 95% CI 1.0–5.6, p = .039. ConclusionsIn total, 41.7% of CSORN patients had minimal engagement with non-pharmacological, non-operative treatment in the six-months prior to ETSS assessment in XXXXXXXX. Factors associated with minimal engagement included: older age, high disability, increased BMI, and female biological sex.