The management of emergency spinal surgery during the COVID-19 pandemic in Italy

Aims The current pandemic caused by COVID-19 is the biggest challenge for national health systems for a century. While most medical resources are allocated to treat COVID-19 patients, several non-COVID-19 medical emergencies still need to be treated, including vertebral fractures and spinal cord compression. The aim of this paper is to report the early experience and an organizational protocol for emergency spinal surgery currently being used in a large metropolitan area by an integrated team of orthopaedic surgeons and neurosurgeons. Methods An organizational model is presented based on case centralization in hub hospitals and early management of surgical cases to reduce hospital stay. Data from all the patients admitted for emergency spinal surgery from the beginning of the outbreak were prospectively collected and compared to data from patients admitted for the same reason in the same time span in the previous year, and treated by the same integrated team. Results A total of 19 patients (11 males and eight females, with a mean age of 49.9 years (14 to 83)) were admitted either for vertebral fracture or spinal cord compression in a 19-day period, compared to the ten admitted in the previous year. No COVID-19 patients were treated. The mean time between admission and surgery was 1.7 days, significantly lower than 6.8 days the previous year (p < 0.001). Conclusion The structural organization and the management protocol we describe allowed us to reduce the time to surgery and ultimately hospital stay, thereby maximizing the already stretched medical resources available. We hope that our early experience can be of value to the medical communities that will soon be in the same emergency situation. Cite this article: Bone Joint J 2020;102-B(6):671–676.

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Metastatic Spinal Cord Compression (MSCC) – Collaborative Work between the Tertiary Cancer Centre and the Specialist Spinal Centre Since the Introduction of the MSCC Coordinator Service Has Seen a Marked Increase in Surgical Rates, with 20% of Patients Who Presented with MSCC in the First 24 Months Having Spinal Surgery. This Has Resulted in Improved Survival Rates for MSCC Patients in Greater Manchester and Cheshire

The Spine Journal ◽

10.1016/j.spinee.2016.12.095 ◽

2017 ◽

Vol 17 (3) ◽

pp. S30-S31 ◽

Cited By ~ 2

Author(s):

Lena Richards ◽

Vivek Misra ◽

Rajat Verma ◽

Susan Greenhalgh

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Spinal Surgery ◽

Collaborative Work ◽

Survival Rates ◽

Cord Compression ◽

Metastatic Spinal Cord Compression ◽

Cancer Centre

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Survival and clinical outcomes in patients with metastatic epidural spinal cord compression after spinal surgery: a prospective, multicenter, observational cohort study

Chinese Journal of Cancer ◽

10.1186/s40880-016-0091-5 ◽

2016 ◽

Vol 35 (1) ◽

Cited By ~ 3

Author(s):

Anick Nater ◽

Michael G. Fehlings

Keyword(s):

Spinal Cord ◽

Cohort Study ◽

Clinical Outcomes ◽

Spinal Cord Compression ◽

Spinal Surgery ◽

Cord Compression ◽

Observational Cohort Study ◽

Observational Cohort

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Evaluation of open and minimally invasive spinal surgery for the treatment of thoracolumbar metastatic epidural spinal cord compression: a systematic review

European Spine Journal ◽

10.1007/s00586-021-06880-7 ◽

2021 ◽

Author(s):

Mohammed Alshareef ◽

Gibson Klapthor ◽

Ali Alawieh ◽

Stephen Lowe ◽

Bruce Frankel

Keyword(s):

Systematic Review ◽

Spinal Cord ◽

Minimally Invasive ◽

Spinal Cord Compression ◽

Spinal Surgery ◽

Cord Compression ◽

Minimally Invasive Spinal Surgery

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Percutaneous surgery for treatment of epidural spinal cord compression and spinal instability: technical note

Neurosurgical FOCUS ◽

10.3171/2016.8.focus16175 ◽

2016 ◽

Vol 41 (4) ◽

pp. E2 ◽

Cited By ~ 9

Author(s):

Claudio E. Tatsui ◽

Telmo A. B. Belsuzarri ◽

Marilou Oro ◽

Laurence D. Rhines ◽

Jing Li ◽

...

Keyword(s):

Spinal Cord ◽

Hospital Stay ◽

Scale Score ◽

Spinal Cord Compression ◽

Systemic Treatment ◽

Cord Compression ◽

Spinal Instability ◽

Spinal Stabilization ◽

Oncological Treatment ◽

Before And After

OBJECTIVE An emerging paradigm for treating patients with epidural spinal cord compression (ESCC) caused by metastatic tumors is surgical decompression and stabilization, followed by stereotactic radiosurgery. In the setting of rapid progressive disease, interruption or delay in return to systemic treatment can lead to a negative impact in overall survival. To overcome this limitation, the authors introduce the use of spinal laser interstitial thermotherapy (sLITT) in association with percutaneous spinal stabilization to facilitate a rapid return to oncological treatment. METHODS The authors retrospectively reviewed a consecutive series of patients with ESCC and spinal instability who were considered to be poor surgical candidates and instead were treated with sLITT and percutaneous spinal stabilization. Demographic data, Spine Instability Neoplastic Scale score, degree of epidural compression before and after the procedure, length of hospital stay, and time to return to oncological treatment were analyzed. RESULTS Eight patients were treated with thermal ablation and percutaneous spinal stabilization. The primary tumors included melanoma (n = 3), lung (n = 3), thyroid (n = 1), and renal cell carcinoma (n = 1). The median Karnofsky Performance Scale score before and after the procedure was 60, and the median hospital stay was 5 days (range 3–18 days). The median Spine Instability Neoplastic Scale score was 13 (range 12–16). The mean modified postoperative ESCC score (2.75 ± 0.37) was significantly lower than the preoperative score (4.5 ± 0.27) (Mann-Whitney test, p = 0.0044). The median time to return to oncological treatment was 5 days (range 3–10 days). CONCLUSIONS The authors present the first cohort of sLITT associated with a percutaneous spinal stabilization for the treatment of ESCC and spinal instability. This minimally invasive technique can allow a faster recovery without prejudice of adjuvant systemic treatment, with adequate local control and spinal stabilization.

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