COVID-19 and Spine Surgery: A Review and Evolving Recommendations

Impact of COVID-19 on Spinal Diagnosis and Procedural Volume in the United States

STUDY DESIGN

Retrospective analysis of a national database.

OBJECTIVES

COVID-19 resulted in the widespread shifting of hospital resources to handle surging COVID-19 cases resulting in the postponement of surgeries, including numerous spine procedures. This study aimed to quantify the impact that COVID-19 had on the number of treated spinal conditions and diagnoses during the pandemic.

METHODS

Using CPT and ICD-10 codes, TriNetX, a national database, was utilized to quantify spine procedures and diagnoses in patients >18 years of age. The period of March 2020-May 2021 was compared to a reference pre-pandemic period of March 2018-May 2019. Each time period was then stratified into four seasons of the year, and the mean average number of procedures per healthcare organization was compared.

RESULTS

In total, 524,394 patient encounters from 53 healthcare organizations were included in the analysis. There were significant decreases in spine procedures and diagnoses during March-May 2020 compared to pre-pandemic levels. Measurable differences were noted for spine procedures during the winter of 2020-2021, including a decrease in lumbar laminectomy and anterior cervical arthrodesis. Comparing the pandemic period to the pre-pandemic period showed significant reductions in most spine procedures and treated diagnoses; however, there was an increase in open repair of thoracic fractures during this period.

CONCLUSIONS

COVID-19 resulted in a widespread decrease in spinal diagnosis and treated conditions. An inverse relationship was observed between new COVID-19 cases and spine procedural volume. Recent increases in procedural volume from pre-pandemic levels are promising signs that the spine surgery community has narrowed the gap in unmet care produced by the pandemic.

Trends in degenerative lumbar spinal surgery during the early COVID-19 pandemic in Republic of Korea: A national study utilizing the national health insurance database

During the first year of the COVID-19 pandemic, the Republic of Korea (ROK) experienced three epidemic waves in February, August, and November 2020. These waves, combined with the overarching pandemic, significantly influenced trends in spinal surgery. This study aimed to investigate the trends in degenerative lumbar spinal surgery in ROK during the early COVID-19 pandemic, especially in relation to specific epidemic waves. Using the National Health Information Database in ROK, we identified all patients who underwent surgery for degenerative lumbar spinal diseases between January 1, 2019 and December 31, 2020. A joinpoint regression was used to assess temporal trends in spinal surgeries over the first year of the COVID-19 pandemic. The number of surgeries decreased following the first and second epidemic waves (p<0.01 and p = 0.34, respectively), but these were offset by compensatory increases later on (p<0.01 and p = 0.05, respectively). However, the third epidemic wave did not lead to a decrease in surgical volume, and the total number of surgeries remained comparable to the period before the pandemic. When compared to the pre-COVID-19 period, average LOH was reduced by 1 day during the COVID-19 period (p<0.01), while mean hospital costs increased significantly from 3,511 to 4,061 USD (p<0.01). Additionally, the transfer rate and the 30-day readmission rate significantly decreased (both p<0.01), while the reoperation rate remained stable (p = 0.36). Despite the impact of epidemic waves on monthly surgery numbers, a subsequent compensatory increase was observed, indicating that surgical care has adapted to the challenges of the pandemic. This adaptability, along with the stable total number of operations, highlights the potential for healthcare systems to continue elective spine surgery during public health crises with strategic resource allocation and patient triage. Policies should ensure that surgeries for degenerative spinal diseases, particularly those not requiring urgent care but crucial for patient quality of life, are not unnecessarily halted.

Impact on Spine Surgery during the First Two Years of COVID-19 Pandemic: A Nationwide Study in South Korea

Since December 2019, the novel coronavirus (COVID-19) has infected people worldwide. Owing to its rapid spread, elective surgeries, including spine surgery, have been re-scheduled. We analyzed nationwide data to investigate changes in the volume of spine surgery during the first two years of the pandemic. Nationwide data from January 2016 to December 2021 were obtained. We compared the total number of patients who underwent spine surgery and related medical expenses before and during the COVID-19 pandemic. In February and September, the number of patients was significantly smaller compared to January and August, respectively. Despite the pandemic, the proportion of patients undergoing spine surgery for degenerative diseases in 2021 was the highest. In contrast, the proportions of patients undergoing spine surgery for tumors showed a continuous decrease from 2019 to 2021. Although the number of spine surgeries performed at tertiary hospitals was lowest in 2020, it was not significantly smaller than that in 2019.The number of patients who underwent spine surgery in March 2020, during the first outbreak, decreased compared to the previous month, which differed from the trend observed in the pre-COVID-19 period. However, as the pandemic continues, the impact of COVID-19 on spine surgery has become less evident.

[How was spinal surgery activity maintained during the COVID-19 pandemic? Results of a French multicenter observational study]

Introduction

La Société française de chirurgie rachidienne (SFCR) a des recommandations pendant la pandémie COVID. L’objectif de ce travail est de rapporter l’organisation et l’activité en chirurgie rachidienne pendant le premier mois de confinement de 6 centres en France. L’objectif secondaire est de contrôler l’adéquation de nos pratiques avec les recommandations de la SFCR.

Matériel et méthode

Il s’agit d’une étude observationnelle multicentrique prospective entre le 16 mars et le 16 avril 2020 rapportant l’activité chirurgicale rachidienne dans chaque institution, ainsi que les modifications organisationnelles appliquées. L’activité chirurgicale était comparée à celle de la même période en 2019 dans chaque centre et évaluée en fonction des recommandations de la SCFR afin de contrôler l’adéquation de nos pratiques en période de pandémie.

Résultats

Pendant le pic de l’épidémie 246 patients dont 6 patients COVID+ ont été pris en charge chirurgicalement. Les baisses d’activité les plus importantes étaient retrouvées à Strasbourg (−81,5 %) et à Paris (−65 %), régions dans lesquelles la situation sanitaire était la plus critique, mais également à Bordeaux (−75 %) malgré une circulation virale moins importante. Un fonctionnement de 20 à 50 % des capacités normales des salles opératoires était noté. La diminution importante des procédures pour rachis dégénératif ou déformations était en adéquation avec les recommandations de la SFCR.

Conclusion

Le maintien d’une activité chirurgicale rachidienne est possible et souhaitable même en période de crise sanitaire. Les indications doivent être réfléchies selon les critères d’urgences élaborés par les sociétés savantes et adaptées à l’évolution sanitaire et aux possibilités techniques de prise en charge par centre.

Niveau de preuve

IV.

How was spinal surgery activity maintained during the COVID-19 pandemic? Results of a French multicenter observational study

INTRODUCTION

The French Society of Spinal Surgery (SFCR) offered guidelines during the COVID pandemic. The objective of this work was to report the organization and activity in spinal surgery during the first month of confinement across 6 centers in France. The secondary objective was to monitor the adequacy of our practices within the SFCR guidelines.

MATERIAL AND METHODS

This prospective multicenter observational study reported spinal surgery activity in each institution from March 16 to April 16, 2020, as well as the organizational changes applied. Surgical activity was compared to that of the same period in 2019 in each center and evaluated according to the SFCR guidelines, in order to control the adequacy of our practices during a pandemic period.

RESULTS

During the peak of the epidemic, 246 patients including 6 COVID-positive patients were treated surgically. The most significant drops in activity were found in Strasbourg (-81.5%) and Paris (-65%), regions in which the health situation was the most critical, but also in Bordeaux (-75%) despite less viral circulation. Operating rooms functioned at 20 to 50% of their normal capacity. There was a significant reduction in procedures for degenerative spine conditions or deformities, in line with the SFCR guidelines.

CONCLUSION

Maintaining spinal surgery is possible and desirable, even in times of health crisis. The indications must be considered according to the emergency criteria developed by learned societies and adapted to health developments and to the technical possibilities of treatment, by center.

LEVEL OF PROOF

IV.

The Effect of the Coronavirus Disease 2019 (COVID-19) Pandemic on Elective Cervical Spine Surgery Utilization and Complications in the United States: A Nationwide Temporal Trends Analysis

OBJECTIVES

As a result of the coronavirus disease 2019 (COVID-19) pandemic, elective surgeries nationwide were suspended. The objective was to compare temporal trends in patient demographics, case volumes, and postoperative complications of patients undergoing elective cervical spine surgery from pre-COVID-19 (2019-2020 Q1) to post-COVID-19 (2020 Q2-Q4).

METHODS

The 2019 to 2020 American College of Surgeon's National Surgery Quality Improvement Program database was queried for common elective cervical spine surgeries. Patients pre-COVID-19 (2019-2020 Q1) were compared with those undergoing surgery during post-COVID-19 (2020 Q2-Q4) protocols. Procedural use, patient demographics, and complications were compared. Linear regression was used to evaluate case volume changes over time. P values less than 0.05 were significant.

RESULTS

In total, 31,013 patients underwent elective cervical spine surgery in 2019 (N = 16,316) and 2020 (N = 14,697); an overall 10% decline. Compared with the calendar year 2019 through 2020 Q1 mean, elective surgery volume decreased by 21.6% in 2020 Q2 and never returned to prepandemic baseline. The percentage decline in case volume from 2019 to 2020 Q1 to 2020 Q2 was greatest for anterior cervical discectomy and fusion (23.3%), followed by cervical decompression (23.4%), posterior cervical fusion (15.0%), and cervical disc arthroplasty and vertebral corpectomy (13.7%). Patients undergoing surgery in 2020 Q2-Q4 had overall greater comorbidity burden (American Society of Anesthesiologists grade 3 and 4) (P < 0.001). From 2019-2020 Q1 versus 2020 Q2-Q4, there was a significant increase in total complication (5.5% vs. 6.8%, P < 0.001), reoperation (1.9% vs. 2.2%, P = 0.048), and mortality (0.25% vs. 0.37%, P = 0.049) rates.

CONCLUSIONS

Elective surgery declined drastically during the second quarter of 2020. Patients undergoing surgery during the pandemic had an overall greater comorbidity burden, resulting in increased total complication and mortality rates over the study period.

Global research hotspots and trends in the field of spine surgery during the COVID-19 pandemic: A bibliometric and visual analysis

Background

The Coronavirus disease-2019 (COVID-19) significantly affected the healthcare and research systems, including spine surgery, throughout the world. A bibliometric analysis allows graphical visualization of the development of an academic field and its frontiers. Since research concerning spine surgery during the COVID-19 pandemic is being constantly upgraded, we conducted a bibliometric analysis of this literature to investigate the current status, research hotspots, and trends in this field.

Methods

We searched the Web of Science database for literature published (from December 1, 2019, to March 24, 2022) using the terms “COVID-19” OR “2019-nCoV” OR “SARS-CoV-2” AND “spine surgery” OR “spinal surgery” OR “discectomy” OR “decompression” OR “laminectomy” OR “interbody fusion” OR “pedicle screws.” Detailed bibliometric and visual analysis of the number of publications, geographical distribution, institutions, journals, authors, and keywords was done using CiteSpace, VOSviewer, and R-Bibliometrix.

Results

Of the initially screened 173 articles, we included 84 relevant articles—62 original articles, 10 editorial materials, 8 reviews, and 4 others. The United States, China, Egypt, and Argentina were most actively publishing in the field of spine surgery and COVID-19. The AOSpine International community contributed 7 articles (24 citations). The Hospital for Special Surgery (13.1%) and Johns Hopkins University (13.1%) were institutions with the most publications. Using the Law of Bradford, we found that World Neurosurgery, Global Spine Journal, and European Spine Journal are the core journals in this field, with P. K. Louie being the most influential author. “Elective surgery,” “intensive care,” “telehealth,” “patient satisfaction,” and “follow-up” had the strongest citation bursts.

Conclusions

During the COVID-19 pandemic, spine surgeons were more concerned with surgical timing, care, treatment, and patient’s quality of life. Accordingly, research hotspots in spine surgery during the pandemic shifted from “early healthcare” to “virus management” and “experience and education.”

A Nationwide Study on the Impact of COVID-19 Pandemic on Volume of Spine Surgery in South Korea

OBJECTIVE

In March 2020, World Health Organization declared a global pandemic caused by a novel coronavirus (SARS-CoV-2). The disease caused by this virus is called COVID-19. Due to its high contagiousness, many changes have occurred in overall areas of our daily life including hospital use by patients. The aim of this study was to investigate the impact of COVID-19 on volume of spine surgery in South Korea using the National Health Insurance database and compare it with the volume of a homologous period before the pandemic.

METHODS

Data of related to spine surgery from January 2019 to April 2021 were obtained from the National Health Insurance and Health Insurance Review and Assessment Service database. Primary outcomes were total number of patients, rate of patients per 100000 population, and total number of procedures. The number of patients by hospital size was also analyzed.

RESULTS

COVID-19 outbreaks occurred in South Korea in March, August, and December of 2020. Compared to the previous year, the total number of patients who underwent spinal surgery showed a decrease for 2-3 months after the first and second outbreaks. However, it showed an increasing trend after the third outbreak. The same pattern was observed in terms of the ratio of the number of patients per 100000 population. Between 2019 and 2021, the mean number of spine surgeries per month tended to increase. Mean annual medical expenses increased over the years (p=0.001). When the number of spine surgeries was analyzed by hospital size, proportion of tertiary general hospital in 2021 increased compared to those in 2019 and 2020 (vs. 2019, p=0.012; vs. 2020, p=0.016). The proportion of general hospital was significantly decreased in 2020 compared to that in 2019 (p=0.037).

CONCLUSION

After the COVID-19 outbreak, patients tended to postpone spinal surgery temporarily. The number of spinal surgeries decreased for 2-3 months after the first and second outbreaks. However, as the ability to respond to the COVID-19 pandemic at the hospital and society-wide level gradually increased, the number of spine surgeries did not decrease after the third outbreak in December 2020. In addition, the annual number of spine surgeries continued to increase. However, it should be noted that patients tend to be increasingly concentrated in tertiary hospitals for spinal surgery.

Spine Patient Satisfaction With Telemedicine During the COVID-19 Pandemic: A Cross-Sectional Study

STUDY DESIGN

Original research, cross-sectional study.

OBJECTIVES

Evaluate patient satisfaction with spine care delivered via telemedicine. Identify patient- and visit-based factors associated with increased satisfaction and visit preference.

METHODS

Telemedicine visits with a spine surgeon at 2 practices in the United States between March and May 2020 were eligible for inclusion in the study. Patients were sent an electronic survey recording overall satisfaction, technical or clinical issues encountered, and preference for a telemedicine versus an in-person visit. Factors associated with poor satisfaction and preference of telemedicine over an in-person visit were identified using multivariate logistic regression.

RESULTS

A total of 772 responses were collected. Overall, 87.7% of patients were satisfied with their telemedicine visit and 45% indicated a preference for a telemedicine visit over an in-person visit if given the option. Patients with technical or clinical issues were significantly less likely to achieve 5 out of 5 satisfaction scores and were significantly more likely to prefer an in-person visit. Patients who live less than 5 miles from their surgeon's office and patients older than 60 years were also significantly more likely to prefer in-person visits.

CONCLUSIONS

Spine telemedicine visits during the COVID-19 pandemic were associated with high patient satisfaction. Additionally, 45% of respondents indicated a preference for telemedicine versus an in-patient visit in the future. In light of these findings, telemedicine for spine care may be a preferable option for a subset of patients into the future.

Trends of Spine Surgeries during the First COVID-19 Semi-Lockdown: Survey in a Non-Epidemic Region in Japan

Introduction

Methods

Results

Conclusions

COVID-19 pandemic: An update on the reaction attitude of the spine societies and their members worldwide

BACKGROUND

All surgical specialties have been influenced by the coronavirus disease 2019 (COVID-19) pandemic, and substantial changes have been determined in medical assistance, especially in elective surgery. Several spine societies have published recommendations to provide optimal care during this unique situation.

AIM

To discuss the recommendations by many spine societies for the management of spinal diseases during the COVID-19 pandemic.

METHODS

The present study was performed according to the PRISMA guidelines. A review of the MEDLINE database (PubMed – National Library of Medicine), Google, and Google Scholar was performed from March 2020 to date for articles published in the English Language.

RESULTS

Spine associations and societies worldwide were divided into three groups: Continental, specialty and country-based societies. A total of 27 spine associations were included in this review. There were eight major continental associations, but only one-third of these had published guidelines and recommendations on this topic. On the other hand, the specialty-based societies have not addressed the topic, except in two cases.

CONCLUSION

The national spine societies showed the deepest concern on this topic with several publications in scientific journals influenced by the local epidemiological severity. Contrarily, continental and specialty-based societies showed less interest in this topic.

Impact of the COVID-19 Pandemic on Elderly Patients with Spinal Disorders

During the ongoing coronavirus disease 2019 (COVID-19) pandemic, home-quarantine has been necessary, resulting in lifestyle changes that might negatively affect patients with spinal disorders, including a reduction in their quality of life (QoL) and activities of daily living (ADLs). However, studies on this impact are lacking. This study aimed to investigate the age-related changes in QoL and ADLs in patients with spinal disorders, and also identify factors associated with decline in ADLs. This multicenter cross-sectional study included patients who visited four private spine clinics for any symptoms. The study participants either had a clinic reservation, were first-time clinic visitors, or had a return visit to the clinic. The participants completed several questionnaires at two points: pre-pandemic and post-second wave. Changes in patient symptoms, exercise habits, ADLs, and health-related QoL were assessed. A logistic regression model was used to calculate the odds ratio (OR) of each variable for decline in ADLs. We included 606 patients; among them, 281 and 325 patients were aged <65 and ≥65 years, respectively. Regarding exercise habits, 46% and 48% of the patients in the <65 and ≥65-year age groups, respectively, did not change their exercise habits. In contrast, 40% and 32% of the patients in the <65 and ≥65-year age groups, respectively, decreased their exercise habits. In the multivariate analysis, the adjusted ORs for sex (female), decreased exercise habit, and age >65 years were 1.7 (1.1–2.9), 2.4 (1.4–3.9), and 2.7 (1.6–4.4), respectively. In conclusion, there was a decline in the ADLs and QoL after the COVID-19 outbreak in patients with spinal disorders. Aging, reduction of exercise habits, and female sex were independent factors related to decline in ADLs.

The impact of the COVID-19 pandemic on spinal surgery

The impact of the coronavirus disease (COVID-19) pandemic on healthcare services around the world has been unprecedented. Surgical specialities, in particular, had to respond rapidly and adapt to continue to meet the needs of their patients in this ever-evolving and uncertain situation. With the cancellation of elective surgery and outpatient clinics, the majority of work carried out by spinal surgeons was obliterated. It was imperative emergency spinal care continued throughout the pandemic, with the creation of guidelines to assist spinal surgeons manage patients appropriately. Alongside assisting on the frontline, spinal surgeons had to triage referrals to ensure urgent care was still provided, undertake outpatient clinics virtually and ensure educational opportunities were available for colleagues. Paediatric spinal surgery was affected by the pandemic; although the virus did not significantly impact children to the same extent, a notable consequence of the lockdown restrictions was a reduction in GP referrals into the specialist service. In the event of any future pandemics, national spinal organizations have created guidelines to assist in the prioritization and care of spinal pathologies. While a 'return to normality' is a long way off, the impact of the past year will undoubtedly change spinal surgeons and their practice forever.

COVID-19 and Acute Cervical Spinal Cord Injury-Case Report of 2 Patients: Do We Need to Rethink Our Standard Treatment Strategy?

STUDY DESIGN

This was a case series.

OBJECTIVE

The authors sought to examine the high-risk population of COVID-positive patients with acute cervical spinal cord injury (SCI) in a large level 1 trauma and tertiary referral center.

SUMMARY OF BACKGROUND DATA

There are limited studies regarding the surgical management of patients with acute SCI in the setting of the recent coronavirus pandemic.

METHODS

The authors describe the cases of 2 patients who died from COVID-related complications after acute cervical SCI.

RESULTS

Patients with SCI are at increased risk of pulmonary complications. COVID-19 infection represents a double hit in this patient population, increasing potential morbidity and mortality in the perioperative time frame. Careful consideration must be made regarding the timing of potential surgical intervention in the treatment of acute SCI.

CONCLUSIONS

Nationwide database of COVID-positive patients with acute spinal cord injury should be collected and analyzed to better understand how to manage acute SCI in the COVID-19 era. The authors recommend preoperative discussion in patients with acute cervical SCI with COVID-19, specifically emphasizing the increased risk of respiratory complications and mortality.

The Virtual Spine Examination: Telemedicine in the Era of COVID-19 and Beyond

STUDY DESIGN

Narrative review.

OBJECTIVES

Describe a comprehensive spine telemedicine examination.

METHODS

We discuss telemedicine examination techniques for commonly encountered spine conditions.

RESULTS

Techniques to evaluate gait, the cervical spine, the lumbar spine, adult spinal deformity patients, and adolescent scoliosis patients via telemedicine are described. We review limitations of the spine telemedicine examination and discuss special considerations such as patient safety and criteria for in-person assessment.

CONCLUSIONS

While there are limitations to the spine telemedicine examination, unique strategies exist to provide important information to the examiner. Efforts have already been undertaken to validate and expand the capabilities of the spine telemedicine examination.

Emergent spine surgery during COVID-19 pandemic: 10 Months experience in Dr. Sardjito general hospital, Indonesia a case series

Background

During the COVID-19 pandemic, the spine surgeon had to deal with some new challenges in treating emergency spine cases. This paper aimed to report our experience with spine emergency surgery during the pandemic, with already limited resources for surgery.

Methods

This was a retrospective, single-center study, involving all patients admitted to our hospital during a period of 1st March - 31^st December 2020 and underwent emergent spinal surgery. The data were collected from the patients' medical records.

Results

We found 15 patients who met the inclusion criteria. Four patients were suspected to be infected by COVID-19, but none of them was confirmed to be infected by COVID-19 based on the PCR test. All patients had a history of injury: fell from height (53.3%), traffic accident (40%), and direct trauma (6.7%). The average time interval from injury to hospital admission was 38.6 h, from admission to surgery was 6.3 days, and from injury to surgery was 8.1 days. The patient who was suspected to be infected with COVID-19 has a significantly greater time interval from admission to surgery (p = 0.012). The surgery lasted for 3-6 h, with an average of 4.6 h. The average hospital stay duration was 13.3 days and it has a significant positive correlation with the time interval from admission to surgery (p = 0.001). Three months post-operatively, seven patients experienced an improvement in the Frankel grade, 4 patients had no changes in Frankel grade, and 2 patients died.

Conclusion

To our experience, the lack of human and material resources during the pandemic caused some delay in surgery. However, surgery performed later than 24 h during the pandemic might still bring benefit to the patient.

Spinal surgery during the COVID-19 pandemic: the experience in a tertiary referral centre

Background

The COVID-19 pandemic first came to prominence in December 2019, and since then has swept the globe, causing one of the largest public health problems seen. It has had a wide-ranging impact on healthcare provision, with a cessation of elective operating. We aimed to assess the impact of COVID-19 on a tertiary referral centre for spinal surgery in England.

Methods

An 82-day study period from 20^th March 2020 to 10^th June 2020 was used, and all spinal surgical patients were followed up prospectively, comparing patients from the same date range in 2019. We assessed rate of COVID transmission, 30-day mortality rates, complication rates and length of hospital stay in a large tertiary Teaching hospital in England.

Results

Seventy-eight patients were operated on during the COVID-19 pandemic period, with a 30-day mortality rate of 4.2%. Two of these deaths were attributable to COVID-19 (2.56%). The mean length of stay was 10.8 days. Neither the 30-day mortality rate or the length of stay was statistically significant compared to the 2019 control period. Five patients (6.4%) tested positive for COVID-19, all were negative at time of surgical intervention. Our complication rate was 10.3% during the COVID-19 pandemic period.

Conclusions

The number of operative cases performed during the COVID-19 pandemic fell by one-third compared to the same period in 2019. The COVID-19 pandemic did not cause a significant increase in 30-day mortality rate, length of stay, or complication rates. Further studies with larger patient numbers and longer-term outcomes will be needed to fully assess the impact of the COVID-19 pandemic on spinal surgery.

Emergency surgical management of cervical spine fracture-dislocation with acute paraplegia in COVID-19 (Coronavirus disease 2019)-suspected patient: first experience from a German spine centre

PURPOSE

We present an organized hospital plan for the management of Coronavirus disease (COVID-19) patients requiring emergency surgical interventions. To introduce a multidisciplinary approach for the management of COVID-19-infected patients and to report the first operated patient in the Corona unit.

METHODS

A detailed presentation of the hospital plan for a separate Corona unit with its intensive care unit and operating rooms. Description of the management of the first spine surgery case treated in this unit.

RESULTS

The Corona unit showed a practical approach for the management of an emergency cervical spine fracture-dislocation with acute paralysis. The patient is 92-year-old female. The mechanism of injury was a simple fall during the stay in the internal medicine department where the patient was treated in the referring hospital. The patient had no other injuries and was awake and oriented. The patient did not have the clinical symptom of COVID-19, and the test result of COVID-19 done in the referring hospital was not available on admission in our emergency room. Education of the medical staff and organization of the operating theatre facilitated the management of the patient without an increased risk of spreading the infection.

CONCLUSIONS

The current COVID-19 pandemic requires an extra-ordinary organization of the medical and surgical care of the patients. It is possible to manage an infected or a potentially infected patient surgically, but a multidisciplinary plan is necessary to protect other patients and the medical staff.

Current effect of COVID-19 global pandemic on the professional and life profiles of the Egyptian spine surgeons

Introduction: During the recent decade, many outbreaks of infectious diseases have been reported at increasing scales and frequency. The novel COVID-19 is the most recent lethal virus and has been declared to be a pandemic disease on March 11th, 2020. It has spread from China to most of the countries around the world causing a great burden on individuals and communities. The socioeconomic and professional profiles have been affected seriously by this pandemic. The aim of this study was to assess the short-term effects of COVID-19 on the socioeconomic profile of spinal surgeons in Egypt. Methods: We conducted a cross-sectional online survey study to address the effect of COVID-19 global pandemic on spine surgeons in Egypt, discussing the short-term socioeconomic effect of COVID-19 global pandemic on the professional and social profiles of the Egyptian spine surgeons. A SurveyMonkey^® questionnaire was sent to 190 spine surgeons registered in the Egyptian spine association database. Results: Ninety male surgeons responded to our four-day survey. The responders included the following: 4 residents, 16 fellows, and 70 consultants working in different Egyptian hospitals. The partial country lockdown was associated with drop in monthly income and in number of both elective and emergency operations. Most surgeons either stopped surgery or limited the number of either elective or emergency surgeries as well as outpatient clinics. Most of them were not in the COVID-19 team or did not receive any training, working under immense physical and psychological stress of being exposed to transmission of infection. Discussion: COVID-19 global pandemic negatively affected spine surgeons in Egypt socioeconomically. The Health Authority and the community have to work jointly to help the health care professionals in overcoming this crisis.

The short-term impact of COVID-19 pandemic on spine surgeons: a cross-sectional global study

Purpose

The outbreak of COVID-19 erupted in December 2019 in Wuhan, China. In a few weeks, it progressed rapidly into a global pandemic which resulted in an overwhelming burden on health care systems, medical resources and staff. Spine surgeons as health care providers are no exception. In this study, we try to highlight the impact of the crisis on spine surgeons in terms of knowledge, attitude, practice and socioeconomic burden.

Methods

This was global, multicentric cross-sectional study on 781 spine surgeons that utilized an Internet-based validated questionnaire to evaluate knowledge about COVID-19, availability of personal protective equipment, future perceptions, effect of this crisis on practice and psychological distress. Univariate and multivariate ordinal logistic regression analyses were used to evaluate the predictors for the degree of COVID-19 effect on practice.

Results

Overall, 20.2%, 52% and 27.8% of the participants were affected minimally, intermediately and hugely by COVID-19, respectively. Older ages (β = 0.33, 95% CI 0.11–0.56), orthopedic spine surgeons (β = 0.30, 95% CI 0.01–0.61) and those who work in the private sector (β = 0.05, 95% CI 0.19–0.61) were the most affected by COVID-19. Those who work in university hospitals (β = − 0.36, 95% CI 0.00 to − 0.71) were affected the least. The availability of N95 masks (47%) and disposable eye protectors or face shields (39.4%) was significantly associated with lower psychological stress (p = 0.01). Only 6.9%, 3.7% and 5% had mild, moderate and severe mental distress, respectively.

Conclusion

While it is important to recognize the short-term impact of COVID-19 pandemic on the practice of spine surgery, predicting where we will be standing in 6–12 months remains difficult and unknown. The COVID-19 crisis will probably have an unexpected long-term impact on lives and economies.