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 Table of Contents  
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 129-130

Impact of COVID-19 on spine surgery: How can we work towards evolving best practices

Head, Department of Spine Surgery, Kothari Medical Centre, Visiting Spine Surgeon, Park Clinic, Kolkata, West Bengal, India

Date of Submission06-Jun-2020
Date of Acceptance06-Jun-2020
Date of Web Publication13-Jul-2020

Correspondence Address:
Dr. Saumyajit Basu
Head Department of Spine Surgery, Kothari Medical Centre, Alipore Road, Kolkata, West Bengal.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/isj.isj_45_20

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How to cite this article:
Basu S. Impact of COVID-19 on spine surgery: How can we work towards evolving best practices. Indian Spine J 2020;3:129-30

How to cite this URL:
Basu S. Impact of COVID-19 on spine surgery: How can we work towards evolving best practices. Indian Spine J [serial online] 2020 [cited 2021 Nov 29];3:129-30. Available from: https://www.isjonline.com/text.asp?2020/3/2/129/289653

The world has changed rapidly in terms of social and professional perspectives ever since the human race has been seriously challenged by the deadly coronavirus. Since the outbreak of the disease in Wuhan in December 2019, this universe has witnessed an unprecedented aggression from this entity threatening to wipe out a significant percentage of the global population. Named as COVID-19 in February 2020, it was declared a global pandemic by World Health Organization (WHO) in March 2020.[1] It has also been established beyond all doubts that health-care workers (HCWs) are at the highest risk of acquiring the infection, which fundamentally exposes all medical practitioners to a menacing health hazard.[2]

  Impact on Spine Surgery Top

The impact of the pandemic on the practice of spine surgery has been huge, and this impact is beyond geographic, economic, and social barriers. Spine surgical procedures dropped by more than 50%,[3] and continued to drop further in the extended lockdown policy adopted by most of the countries affected by this deadly virus. The largest drop occurred in relation to the degenerative spine pathologies, especially those of lumbar stenosis or prolapsed intervertebral disc (PID). Additionally in a country like ours where road traffic accidents are a regular phenomenon, the incidence of spinal trauma is expected to come down because of the massive travel restrictions imposed by the government in an attempt to combat the spread of this highly infectious disease. This gives the spinal community a self-pondering window to assess whether some “elective surgery” is avoidable and if at all necessary.[4] This opportunity to understand the natural history of various degenerative pathologies might not be available for possibly the next few decades or generations of spine specialists. Elective surgery for spinal deformities has obviously nose-dived though all surgeries focusing on prevention or treatment of major neurological deficits have been reasonably spared.

  Impact on Spine Surgeons Top

AO Spine conducted the “COVID-19 and Spine Surgeon Global Impact” survey. A total of 902 surgeons participated, and similarities were noted in family health concerns, including the challenges of testing themselves for COVID along with the difficulties of usage of PPE for a prolonged period. The impact on training and research was significant, and the need for online education was felt immensely. The demand for standardized guidelines for patient care and treatment was echoed across the entire community of spine specialists. In the section on special comments, most spine surgeons stressed on hope and optimism, not undermining the value of caution and safety.[5] Most surgeons were apprehensive of resuming clinical work and were concerned about the extra burden of clinical practice once the lockdown was over.

  Current Guidelines Top

The current guidelines regarding triage of the surgical case load are extremely pertinent because in many spine patients, an inordinate delay can result in irreversible progression of myelopathy and/or neurological dysfunction, whereas in the others, it might just unfold an opportunity to provide extended conservative care with reasonable success. Also, the current scenario has an embedded element of uncertainty, making it impossible to predict a time frame of normalization of surgical scheduling. At one end of the spectrum of surgical indications are those that require immediate attention such as trauma, epidural abscess, spinal tumors, and cauda equina syndrome. On the other end of the spectrum lie those patients having degenerative disorders with significant medical comorbidities for whom the increased rate of complications might be potentially life-threatening. The Rothmans Institute has published the following three levels of spine surgical indications[6]—Level 1 includes those that require immediate attention such as major spine fractures, epidural abscess, or cauda equina syndrome. Level 3 includes those that need deferred surgical scheduling such as adult spinal deformity correction. In the intervening Level 2 category are those that merit a conservative trial of a few weeks or months such as lumbar or cervical disc herniations producing radiculopathy.

The guidelines regarding getting all elective surgical patients to have COVID testing done before surgery and maintaining the policy of residential (7 days on and 7 days off) OT staff along with maintaining strict control over entry of persons in OT have been adopted by many hospitals. Similarly, temperature screening, sanitization, and adherence to social distancing measures in outpatient area are vitally important. Curbing the number of visitors and relatives in hospitals along with the extensive use of telemedicine facilities would ensure the decrease of average footfalls per day in the hospital.

  Future Predictions Top

The future is in the womb of darkness—having said that, the current predictions that we have to encourage lifestyle modifications for at least a year or two should be borne in mind. Complete eradication of the virus is a long way to go. Recent spate of drug usage is predominantly those of permutations and combinations of various antiviral, antimalarial, and immune modulators. Unfortunately, none has shed enough light to overcome the darkness of uncertainty and bridge the gaps in the current understanding of this infectious entity. Although we await the development of a vaccine with bated breath, the real picture remains gloomy. Hence, it is of paramount importance that we align ourselves to serving the patients in need of spine care without endangering ourselves, our families, and our reputation. On a similar note, we should adopt emerging technological options for remote learning and use these to impart education and training and earnestly resume all our research endeavors that make our scientific community unique.

We shall certainly overcome the challenges in due course. It is only a matter of time that we evolve ourselves to find an answer to this colossal problem. If we have withstood so many challenges down the corridors of history, there is no reason why we would not be able to combat the current threat as a united community of dedicated spine surgeons.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Chhabra HS, Bagaraia V, Keny S, Kalidindi KKV, Mallepally A, Dhillon MS, et al. COVID-19: Current knowledge and best practices for orthopaedic surgeons. Indian J Orthopaed2020;54: 411-425.  Back to cited text no. 1
Udwadia ZF, Raju RS. How to protect the protectors: 10 lessons to learn for doctors fighting the COVID-19 coronavirus. Med J Armed Forces India 2020.  Back to cited text no. 2
Meyer M, Prost S, Farah K, Denis JB, Dufour H, Blondel B, et al. Spine surgical procedures during coronavirus disease 2019 pandemic: Is it still possible to take care of patients? Results of an observational study in the first month of confinement. Asian Spine J 2020;14:336-40.  Back to cited text no. 3
Epstein NE. COVID-19 provides an opportunity to reassess how frequent and how extensive elective spine surgery should be. Surg Neurol Int 2020;11:58.  Back to cited text no. 4
Louie PK, Harada GK, McCarthy MH, Albert TJ, An HS, Samartzis D, et al. The global spine community and COVID-19: Divided or united? Spine (Phila Pa 1976) 2020;45:E754-E757.  Back to cited text no. 5
Donnally CJ 3rd, Shenoy K, Vaccaro AR, Schroeder GD, Kepler CK. Triaging spine surgery in the COVID-19 era. Clin Spine Surg 2020;33:129-30.  Back to cited text no. 6


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