Spine Surgery in Singapore Amid COVID-19
JBJS’s first COVID-19 article was about the experiences of orthopaedic surgeons in Singapore. The latest one also comes from authors in Singapore. Soh et al. focus on the impact the pandemic has had on spine surgery in that country. The authors emphasize the need to constantly review and adapt policies amid the moving target that the COVID-19 pandemic represents.
Here’s what the spine service at Soh et al.’s institution (a tertiary hospital and major trauma center) did during the first 6 weeks of the outbreak, which began in Singapore in January:
- Reduced elective spine surgeries by 50%, cancelling all spinal-deformity or revision cases and prioritizing minimally invasive and endoscopic cases that required a shorter length of stay
- Expedited all discharges with transfers to rehabilitation facilities to free up hospital beds
- Rescheduled all non-urgent spine appointments, such as those for acute back pain without neurologic complications
- Offered day-surgery nerve root injections to patients with intractable radicular symptoms
- Continued to receive and operate on emergency spinal trauma and tumor cases
As of April 7, 2020, Singapore instituted a series of heightened measures, collectively referred to as a “circuit breaker,” to further curb community spread of the virus. When the “circuit breaker” kicked in, the spine service again modified its practices. Regular operating and outpatient caseloads were further cut from 50% to 30%. Spine surgery was limited to instances in which a prolonged delay could lead to an irreversible deterioration of function that would negatively impact both the work status and quality of life of the patient.
Precautions during spine surgery are similar to those described by Liang et al for other orthopaedic procedures. Patients with confirmed or suspected COVID-19 and those with pneumonia and unknown COVID-19 status are operated on in a designated OR to avoid contamination of the main operating room and of other patients. In addition:
- Only selected equipment is brought into the OR to reduce the number of items that require cleaning after the procedure.
- The presence of health-care personnel is kept to a minimum to minimize exposure.
- The use of electrocautery is also minimized, with liberal use of suction to remove smoke and aerosols.
Soh et al. also address resident-training issues that were raised in an earlier JBJS fast-tracked article, urging that trainees be reassured they will not be penalized if called upon to modify or sacrifice their training for other responsibilities during this time.
The authors conclude with an acknowledgment of the emotional stress that accompanies a crisis like the COVID-19 pandemic: “During times of crisis, it is important to manage the fears and anxieties of our colleagues as early as possible,” they say. The orthopaedic community must “not forget to look out for one another and bear burdens for one another during this unprecedented time.”