Spine surgery after the COVID-19 emergency: an algorithm for management of elective surgical cases

INTRODUCTION: During the COVID-19 pandemic emergency, all non-urgent surgical procedures including elective spine surgery were performed. Now many countries have passed over the epidemic peak and the time to organize re-opening of non-essential activities has come. After the emergency phase of the COVID-19 pandemic, the viral outbreak is supposed to reduce but will not reasonably disappear until a vaccine is available. Resuming elective spine surgery while ensuring safety for patients and healthcare workers has become an issue of critical importance. We propose a simple algorithm with the aim to help worldwide spine surgeons in management of elective spine surgery cases after the COVID-19 emergency ensuring safety for patients and healthcare workers. METHODS: An expert panel composed by Spine Surgeons, Neurosurgeons, Anesthesiologists and Intensivists with direct experience in COVID-19 management developed an algorithm for management of elective spine surgery based on evidence-based indications. The algorithm has been used for management of hospital admissions of undelayable spine surgery cases during the COVID-19 emergency period. Data regarding COVID-19 nosocomial transmission on patients and healthcare workers have been retrospectively reviewed and reported. RESULTS: Hospital admissions of 159 patients have been managed according to the proposed algorithm. Since the application of the protocol, we have not reported COVID-19 nosocomial transmission in our department. CONCLUSIONS: According to our preliminary results, we think that the proposed algorithm may successfully help management of spinal elective surgical patients in the post-COVID-19 emergency era, avoiding unnecessary risks for patients and healthcare workers.