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

INTRODUCTION: In the early phase of the coronavirus disease 2019 (COVID-19) pandemic, the importance of triaging surgeries was suggested to reduce burdens on the existing health system and maintaining service. The governor declared a state of emergency and requested that residents avoid going out unnecessarily (semi-lockdown) for the entire prefecture including our medical region from February 28 until May 25, 2020. However, for several spine patients, a significant delay in care may result in the progression of extremity weakness and pain. This study aimed to investigate trends of spine surgeries during the first COVID-19 semi-lockdown in the nonepidemic region in Japan. METHODS: Spine surgeries performed in our institution from February 28 until May 25 between 2017 and 2020 were retrospectively reviewed and analyzed. We compared the number of spine surgeries and types of surgical spine pathologies between 2017 and 2019: previous years and 2020: a COVID-19 year. RESULTS: The mean number of spine surgeries performed in previous years was 121 cases, and the number of spine surgeries performed in a COVID-19 year was 109 cases. The percentage of urgent surgeries was 19.6% in previous years versus 37.6% in a COVID-19 year; the difference was statistically significant (P<0.05). Among the urgent surgical spine pathologies, the prevalence of cauda equina or severe nerve root compression leading to progressive neurological deterioration or intractable pain was 20.2% in a COVID-19 year, which was significantly higher than 12.4% in previous years (P<0.05). CONCLUSIONS: The first COVID-19 semi-lockdown in Japan led to a decrease in elective cases and an increase in urgent cases and might affect progressive neurological deterioration for some spine patients even in a nonepidemic region.