COVID-19 and Spine Surgery
Overview
As we’ve all learned these past years, COVID-19, caused by the SARS-COV-2 virus, can lead to a highly variable spectrum of disease, ranging from mild respiratory illness to severe pneumonia, respiratory failure, and death. The symptoms in most patients are mild and include fever, cough, and fatigue. Other less common symptoms include sputum production, headache, and diarrhea.
About 80% of patients develop mild to moderate disease, 14% have severe disease with shortness of breath, and 6% may develop a hyperinflammatory response, septic shock, or acute respiratory distress syndrome (ARDS), which may require mechanical intervention or extracorporeal membrane oxygenation.
Risk Factors
The median age of COVID-19 patients who develop symptoms is 47 years, and most cases occur in patients aged between 30 and 79 years. About 58% of cases occur in males, and less than half of the patients have underlying chronic medical conditions.
Patients who are 80 years and older have a higher mortality rate of approximately 15%, and the overall mortality rate is 2.3%. The mortality rate is also higher in patients with comorbidities such as cardiovascular disease, diabetes, pulmonary disorders, and cancer. Epidemiological data on COVID-19 is continually being analyzed and published.
Diagnosis
To diagnose COVID-19, healthcare providers obtain the patient’s epidemiological history, clinical symptoms, lab results, and diagnostic imaging, as necessary. Reverse transcription-polymerase chain reaction (RT-PCR) and real-time RT-PCR are currently used to detect the SARS-COV-2 virus in respiratory samples.
But false negatives can occur due to various factors such as sample quality, sampling technique, and viral load. Serology antibody testing is also being developed for diagnosis and to assess prior exposure and immunity, but is not yet widely available.
Treatment
Currently, there are no approved treatments for COVID-19, and management focuses on early detection, isolation, and treatment of viral symptoms. However, there are 282 studies registered at clinicaltrials.gov investigating the efficacy and safety of various medications and vaccines for COVID-19. Off-label and compassionate use therapies have been reported using medications such as remdesivir, ribavirin, favipiravir, lopinavir-ritonavir, chloroquine, hydroxychloroquine, azithromycin, steroids, and convalescent plasma.
Several drugs, such as hydroxychloroquine, chloroquine, remdesivir, ribavirin, favipiravir, lopinavir-ritonavir, azithromycin, steroids, and convalescent plasma, have been used in compassionate use therapies or off-label for COVID-19 treatment. However, there is no approved treatment to date, and clinical trials are investigating the efficacy and safety of these medications.
Studies on hydroxychloroquine and chloroquine have shown mixed results with some indicating a potential benefit, while others demonstrated no clinical benefit. The main limitations of most studies are small sample sizes, lack of randomization, and the absence of a control group, which prevents these medications from being widely recommended.
Amidst the current pandemic, doctors at Complete Orthopedics are responsible for treating patients with spinal issues in a safe and efficient manner while conserving healthcare resources. This is especially important as many of these patients may be at a higher risk of developing severe COVID-19 due to age and underlying medical conditions.
Spine Surgery During the Pandemic
Various medical organizations have released guidelines to help healthcare professionals prioritize patients with spinal conditions that require immediate or urgent surgery over those who can wait for several months. The aim is to reduce the consumption of healthcare resources.
However, there is still a lack of agreement on how to identify and triage patients in this area. Triage for spine surgery presents distinctive difficulties, and the severity of cases may surpass that of numerous other surgical fields.
It is important not to postpone cases involving progressive or severe neurologic deficits resulting from neurologic compression due to any cause, spinal instability that may lead to neurologic injury, epidural abscesses accompanied by neurologic deficits, and postoperative wound infections.
If local healthcare guidelines permit and there are sufficient healthcare resources to safely perform the procedure, cases involving myelopathy that has progressed recently, spinal infections that are unresponsive to medical treatment, persistent neurologic deficits that are not severe, and spinal conditions that result in intractable pain or functional limitations that restrict activities of daily living and self-care should be addressed.
It is advisable to delay addressing spinal conditions that can be adequately managed without surgery, and where pain and dysfunction can be reasonably controlled through non-operative means.
It is highly recommended to test all patients for COVID-19 before urgent or emergent spine surgery. This is because patients can be asymptomatic. In cases where testing is not possible or delaying surgery is not an option, it should be assumed that the patient has COVID-19, and appropriate precautions should be taken during the surgical procedure.
Operating Room Setup
When operating on patients with COVID-19, specialized operating rooms will be available. ORs will be converted to negative pressure rooms to minimize the outflow of contaminated air. In situations where this is not possible, measures such as covering all instruments, stocking sufficient equipment and supplies, and using disposable equipment will be implemented to minimize operating room traffic.
In order to reduce the risk of viral transmission during surgery, our doctors will consider using minimally invasive techniques, positioning the patient in a prone position, and avoiding bodily fluid splatter. Additionally, the use of a smoke evacuator will be considered to minimize electrocautery smoke in the operating room.
Intubation and Extubation
Transmission of SARS-CoV-2 can occur through direct contact with respiratory droplets or indirectly through exposure to aerosolized viral particles or contaminated surfaces. Intubation and extubation are considered the most risky aspects of spine surgery for these reasons. Performing intubation in a negative pressure room will be considered whenever it is feasible.
During the intubation procedure, all nonessential staff will leave the room. The use of video laryngoscopy may be considered as an alternative to direct laryngoscopy to maintain a safe distance between our doctors and the patient. Our staff will wait for 15 to 30 minutes after intubation and extubation before reentering the OR.
Postoperative Recovery
Adequate sedation and muscle relaxation will be provided to the patient after the surgery to prevent coughing or movement during transfer, and they should be transported through dedicated routes and elevators.
Call/Inpatient Management
During a pandemic, spinal injuries are expected to occur less frequently due to quarantine and government orders for people to stay at home. However, regular spinal conditions such as trauma will still occur.
That’s why our doctors at Complete Orthopedic will still be on call, promptly assessing patients in the emergency department, and providing care for hospitalized individuals. Our team has specific roles including managing inpatients, performing surgeries, providing on-call evaluations, or overseeing outpatient settings.
Telemedicine offers a way to reduce the risk of exposure for healthcare providers and enable patients to adhere to public health guidelines by staying at home during the pandemic.
Patients who need to be examined in person should undergo screening procedures to detect any symptoms related to COVID-19, or the likelihood of having such symptoms, that would require additional testing.
COVID-19 pandemic is unparalleled in contemporary times. As healthcare providers, and advocates for public health, our surgeons at Complete Orthopedics have a vital responsibility to fulfill. Properly categorizing patients who require urgent or emergent surgery versus those whose surgical needs can be safely postponed will aid in conserving healthcare resources that can be redirected towards treating COVID-19 patients.
Reducing the risk of healthcare worker infections can be achieved by enhancing safety measures for healthcare providers in both the inpatient setting and operating room. Finally, utilizing telemedicine to the fullest extent possible in the outpatient setting can aid in public health efforts aimed at reducing the spread of the virus through community transmission.
If you are interested in knowing more about Covid-19 and Spine Surgery you have come to the right place!
Do you have more questions?
What precautions are taken to ensure my safety during spine surgery amidst the COVID-19 pandemic?
We take multiple precautions to ensure patient safety during spine surgery, including preoperative COVID-19 testing, using specialized operating rooms, minimizing operating room traffic, and employing techniques to reduce viral transmission such as using smoke evacuators and performing intubation in negative pressure rooms. All staff members use personal protective equipment (PPE) to protect both patients and themselves.
What should I expect during the preoperative COVID-19 testing process?
Before your surgery, you will undergo a COVID-19 test, typically a nasal swab RT-PCR test, to determine if you have an active infection. This helps us plan your surgery safely. If your test is positive, we may need to postpone your procedure unless it’s an emergency.
How are emergencies handled if a COVID-19 test cannot be done in time?
If a COVID-19 test cannot be performed in time for an emergency surgery, we will proceed with the assumption that you may be COVID-19 positive. We will use the highest level of precautions, including full PPE for all staff, specialized operating room setups, and minimizing exposure during procedures.
What are the risks if I need spine surgery during the COVID-19 pandemic?
The primary risks include potential exposure to COVID-19 in the hospital setting and complications from the virus if you are infected. We mitigate these risks by following strict infection control protocols. Additionally, the surgical risks remain the same as they would outside of a pandemic, such as infection, bleeding, and complications related to anesthesia.
How will my postoperative care be managed to reduce the risk of COVID-19 exposure?
Postoperative care will include measures to minimize your exposure to COVID-19, such as adequate sedation to prevent coughing, using dedicated routes and elevators for transportation, and possibly discharging you as soon as it is safe. Follow-up visits might be conducted via telemedicine to reduce the need for in-person contact.
What conditions would require urgent or emergent spine surgery during the pandemic?
Conditions requiring urgent or emergent surgery include severe neurologic deficits due to spinal cord compression, spinal instability risking neurologic injury, epidural abscesses with neurologic deficits, and postoperative wound infections. These conditions cannot be delayed and need prompt surgical intervention.
Can my spine condition be managed non-operatively during the pandemic?
Many spine conditions can be managed non-operatively with pain management, physical therapy, and other conservative treatments. We will assess your specific condition to determine if non-surgical management is appropriate, especially if your symptoms can be reasonably controlled without surgery.
What happens if I develop COVID-19 symptoms after my surgery?
If you develop COVID-19 symptoms after surgery, contact our office immediately. We will guide you on the next steps, which may include COVID-19 testing and appropriate medical care. Your postoperative care plan will be adjusted to ensure your recovery while managing any COVID-19 related issues.
Is telemedicine effective for spine care during the COVID-19 pandemic?
Yes, telemedicine is effective for many aspects of spine care. It allows us to assess your condition, manage symptoms, and follow up on your progress while minimizing your risk of exposure to COVID-19. In-person visits are reserved for situations where physical examination and direct intervention are necessary.
Will the use of minimally invasive techniques affect my surgery’s outcome?
Minimally invasive techniques are often preferred, especially during the pandemic, as they can reduce surgery time, decrease blood loss, and promote quicker recovery. These techniques are designed to achieve similar outcomes to traditional surgery with added benefits of reduced hospital stay and lower infection risk.
How long will it take to resume elective spine surgeries once the pandemic eases?
The timeline for resuming elective spine surgeries will depend on local healthcare guidelines and the availability of resources. Once it is deemed safe, elective surgeries will be scheduled based on the urgency of the condition and the backlog of cases. We will keep you informed about the scheduling process.
What are the signs that my spine condition needs urgent attention during the pandemic?
Signs that your spine condition requires urgent attention include sudden onset or worsening of neurological symptoms such as numbness, weakness, or loss of bowel or bladder control, severe and unrelenting pain, or symptoms of an infection like fever, redness, and swelling around a previous surgical site.
How can I manage my pain if my surgery is delayed due to COVID-19?
Pain management can include medications such as anti-inflammatory drugs, muscle relaxants, and pain relievers. Physical therapy exercises, hot/cold therapy, and techniques like acupuncture or chiropractic care may also help. Your doctor will tailor a pain management plan to your specific needs.
. What should I do if I am exposed to COVID-19 shortly before my scheduled surgery?
If you are exposed to COVID-19 shortly before your surgery, inform our office immediately. We will likely need to reschedule your surgery to ensure your safety and the safety of our staff. You may need to quarantine and get tested for COVID-19 before any surgical intervention.
Will I need to quarantine after my surgery if I am not infected with COVID-19?
You won’t necessarily need to quarantine after surgery if you are not infected with COVID-19, but it is advisable to limit your exposure to others to reduce your risk of contracting the virus during your recovery. Follow any specific guidelines provided by your healthcare team.
How is the decision made whether to proceed with or postpone my surgery?
The decision to proceed with or postpone surgery is based on several factors, including the severity of your condition, the risks of delaying surgery, your overall health, and the current status of the healthcare system. We prioritize cases based on urgency and the potential for harm if surgery is delayed.
Are there any special instructions I need to follow before coming to the hospital for surgery during the pandemic?
Yes, you will likely need to follow specific instructions such as undergoing a COVID-19 test, self-isolating for a certain period before surgery, and following enhanced hygiene practices. Detailed preoperative instructions will be provided by our team to ensure your safety.
How do you handle postoperative care for patients who test positive for COVID-19 after surgery?
If a patient tests positive for COVID-19 after surgery, we implement strict isolation protocols to prevent virus spread. The patient will receive care in a designated area, and our team will use full PPE. Treatment will focus on both postoperative recovery and managing COVID-19 symptoms.
What should I do if my condition worsens while waiting for surgery?
If your condition worsens, contact our office immediately. We may need to reassess the urgency of your surgery or adjust your treatment plan. It’s important to keep us informed about any changes in your symptoms so we can provide the best possible care.
These additional questions and answers address various concerns a patient might have, offering comprehensive information to ensure they feel informed and reassured about their care during the COVID-19 pandemic.
Can my family visit me in the hospital after my surgery during the pandemic?
Visitor policies vary by hospital and are influenced by the current state of the pandemic. Many hospitals restrict visitors to minimize the risk of COVID-19 transmission. We recommend checking with our office or the hospital for the most current visitor guidelines.
I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.
Please take a look at my profile page and don't hesitate to come in and talk.
