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.