Acute spine care services during covid-19 pandemic and ‘lockdown’: case series and our perspective from a level 1 trauma centre

Abstract

Study design Case Series. Objective Sudden ‘lockdown’ to contain spread of SarsCoV-2 infection had far-reaching consequences on the Spine Unit of our tertiary care hospital, situated in a hilly-region of Northern India. We intend to share our experience of providing care for acute spinal disorders from 23rd March, 2020, when nationwide lockdown and closure of elective services started in our country, to till 12th May, 2020, and to formulate few recommendations at the end. Setting Northern India. Methods Between 23rd March, 2020 and 12th May, 2020, data of all patients with spinal conditions presenting to Emergency Department for acute care services were collected prospectively. Existing protocols were modified in line with changing national and institute policies for functionality of the spine unit, challenges faced and steps taken were noted. Results All elective cases were postponed for an indefinite period at the starting of ‘Lockdown’. A total of 24 patients were received in ED during study period and 14 (58%) were managed operatively. The majority (79%) were with traumatic spine injury, and fall from height was most common mechanism of injury in traumatic spine patients (84%). There was higher incidence of surgical site infections (14%) among operated patients, compared to our previous average. We had modified routine policies to tackle challenges faced and till date of writing this article, none of the members of spine team or patients treated by us tested positive for SARSCoV-2. Conclusion To continue providing care for acute spinal conditions and maintaining academic activities of spine unit during ‘lockdown’ needs innovative policies in line with national protocols.

COVID-19 and Spontaneous Resolution of Lumbar Disk Prolapse: A Retrospective Cohort Study of Patients Awaiting Microdiscectomy

“…The existing literature covering the impact of the COVID-19 pandemic on spinal surgery mainly focusses on the changing neurosurgical workload (i.e., numbers of referrals, emergency attendances, surgeries performed), infection rates, and the efficacy of COVIDrelated implementations within the service 2,3,9,[11][12][13]35,41,44,[46][47][48][49] . Spinal surgery case volume was reported to have decreased by 52-70% over the pandemic 10,35 .…”

“…Spontaneous resolution is reported to occur in up to 70% of cases without the need for surgical intervention 1 , however, we currently cannot predict for whom and exactly when this will occur. Conservative, non-surgical approaches are used to manage the symptoms of all LDP patients in the first instance; including analgesia, physiotherapy, and involvement of a multi-disciplinary pain team 2,3 .…”

“…During this time, the NHS had to mobilise resources to combat the huge strain on the health service and minimise the spread of COVID-19 infection. This resulted in limitations within the elective spinal service 2,3 . Firstly, there was a significant reduction in spinal clinical appointments.…”

“…Conservative, nonsurgical approaches are used to manage the symptoms of all LDP patients in the first instance, including analgesia, physiotherapy, and involvement of a multidisciplinary pain team. 2,3 In our service pathway, a patient with LDP who continues to experience nontolerable radicular pain after 8 to 12 weeks of nonsurgical approaches 4 or experiences any major neurologic deficit 5 (e.g., foot drop) will be referred for magnetic resonance imaging (MRI) of the lumbar spine by their general practitioner (GP) or physical therapist. If there is radiologic evidence of nerve root compression by a herniated lumbar disk, the patient will be referred to the neurosurgical service.…”

“…This resulted in limitations within the elective spinal service. 2,3 First, there was a significant reduction in spinal clinical appointments. Patients referred to our center were required to go through a vetting process prior to being considered suitable for a clinic appointment, meaning a prolonged period between GP referral and consultation with a spinal surgeon.…”