key: cord-0012009-rvjmkcjk
authors: Jain, Nickul S.; Wang, Jeffrey C.
title: COVID-19 and the Role of Spine Surgeons
date: 2020-05-18
journal: Neurospine
DOI: 10.14245/ns.2040202.101
sha: 93c93a857b60deeaa47d12f83896d922f4ff931a
doc_id: 12009
cord_uid: rvjmkcjk

nan

The identification and triaging of patients with spinal pathology that need emergent or urgent surgery versus those who can be delayed several months is a gray zone without clear consensus. Spine surgery triage has its own unique set of challenges and the acuity of cases may be higher than many other surgical specialties. However, the North American Spine Society has published guidelines on triaging spine case priority during this pandemic and should serve as a general guideline for most spine practitioners for judicious case selection. 2 Recent publications have also suggested that the rates of asymptomatic carriers of COVID-19 can be up to 20%-41% of total patients and COVID-19 positive patients undergoing elective surgical procedures can have disastrous outcomes with potentially up to 20% mortality. [3] [4] [5] However, it is almost certain that treatment delays will increase morbidity among those with severe or debilitating degenerative spine pathology. This tradeoff is at the heart of the matter and emphasizes the critical role spine surgeon decision making plays during this global pandemic. We encourage surgeons to continue to provide direct patient care via telemedicine and outpatient management of painful and debilitating conditions to avoid hospital and clinic visits while limiting patient morbidity.

When surgery is required, spine surgeons should take an active role taking the viral threat seriously and encourage appropriate perioperative and intraoperative precautions. Special consideration should be given to OR setup, negative pressure rooms, limiting OR personnel, preoperative testing, minimizing blood loss, minimally invasive techniques, appropriate PPE use, and intubation and extubation precautions.

As we become more aware of the disproportionate morbidity and mortality of COVID-19 among healthcare workers, new challenges will arise. As frontline treating physicians succumb to COVID-19 or are forced to self-quarantine due to exposures, hospitals will face increased needs for physicians. As spine surgeons, being available and trained for redeployment into medical or COVID wards can help offset the burden of hospitalists, internists and intensivist physicians. Spine surgeons can, in addition to urgent and emergent spine care, potentially aid in doc-umentation, follow-up medical care, screening, and maximizing time for these critical frontline physicians.

During these difficult times, it is important that we all take a few minutes for self-care as well. Making time for family, connecting with colleagues and friends, and getting some form of physical activity can be effective stress mitigation strategies and should not be forgotten while societal limitations are in place. Academic productivity is another potential use of newfound time during the pandemic.

As the number of COVID-19 cases plateaus, a slow return to elective spine surgery will be both necessary and feasible. However, as we adapt to a new way of life, we must remain both vigilant and flexible-always prioritizing health, safety, and wellbeing of patients above all else.

Johns Hopkins University & Medicine; c2020

Burr Ridge (IL): NASS

Estimating the asymptomatic proportion of coronavirus disease 2019 (COV-ID-19) cases on board the Diamond Princess cruise ship

Estimation of the asymptomatic ratio of novel coronavirus infections (COV-ID-19)

Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection

Title: The Old Guitarist Artist: Pablo Picasso Year: 1903 Year: -1904 The Old Guitarist was painted in 1903, just after the suicide death of Picasso's close friend, Casagemas. During this time, the artist was sympathetic to the plight of the downtrodden and painted many canvases depicting the miseries of the poor, the ill, and those cast out of society.He too knew what it was like to be impoverished, having been nearly penniless during all of 1902. This work was created in Madrid, and the distorted style (note that the upper torso of the guitarist seems to be reclining, while the bottom half appears to be sitting cross-legged) is reminiscent of the works of El Greco More information: https://www.pablopicasso.org/old-guitarist.jsp