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The world is suffering right now due to the novel coronavirus which has first emerged in the People’s Republic of China, Wuhan. The virus has evolved incredibly dangerously where the first cases were noticed in December 2019. The subsequent and abnormal spread of COVID19 (the disease caused by the virus) pandemic has led it to a global threat, which was declared by the World Health Organization(WHO), public health emergency on January 30, 2020. As of April 20, 2020, a total of 24,04,249 cases have been listed globally, which took the life of 1,65,234 people worldwide.

The spine surgeons in the orthopaedic department are also actively working with other specialists in screening centres in this pandemic situation. Though the situation may be novel for orthopaedic spine surgeons, most of them are involved in the evaluation of COVID-19 suspect cases; they took the challenge and were ready to serve at the front lines, supporting their colleagues during the time of need.

Evolving Strategies To Sustain COVID-19 Pandemic

The response of INDIA to COVID-19 is really incredible. The measures taken by the government and the support by the public is a graduated one. At the beginning of the outbreak of novel coronavirus, the community spread was limited by taking specific measures; they initiated social distancing, self-quarantine measures in day-to-day life to halt community spread. As of April 20, 2020, the number of transmitted cases increasing at an alarming rate, India started to intensify measures, collectively referred to as a “chain breaker,”.

The measures implemented were like the closing of schools, shopping malls, and physical workplaces. This stepwise approach helped the country to handle COVID19 as most of the countries failed to do so. In the same way, in our spine service, we also have taken similar measures and approaches in changing our practice considering the severity of the situation to ensure the safety of all health-care workers.

The Impact Of COVID19 On Spine Services

In the first few weeks after the outbreak of COVID19, the spine services were re limited to emergency cases only as per the government of India directive . After surgery, we are actively discharging all patients or transferring them to a rehab facility to minimize the gatherings. However, at Medicover Hospital, we are treating all emergency conditions with adequate precautions. Because we had to cut down the staff which limited to less anaesthesia & nursing staff, and perioperative support. Even during these times of crisis , the patients who need emergency care are being treated to the highest standard.

With the administration of the “chain breaker,” we have modified our
practice, according to the Ministry of Health guidelines. As a result, we have limited our working hours and regular operating and outpatient cases also, and now we have defined our cases that require a surgical intervention to prevent neurological deterioration. Spine surgery is a unique procedure compared to other elective orthopaedic procedures, which are mentioned as “essential services” according to Ministry of Health criteria.

Apart from spinal trauma, tumours, and other emergency spinal conditions, there were some instances in which an extended delay in surgical intervention might lead to an irreversible degeneration of function that negatively impacts on quality of life of the patient. Such cases like cervical myelopathy will need intervention as soon as the circumstances permit . Delay may compromise the long term outcomes and hence may need intervention sooner.

Our main aim is to prioritize emergency cases but not cancelling critical surgeries altogether. It is our responsibility to maintain sustainability, and we try to balance our efforts in the long run against COVID-19 with our sole duty to care for our spine patients. All over the world elective work is put on hold as hospitals are gearing up their resources to face the pandemic .

COVID19 Precautions In Case Of Spine Surgery

As the cases of COVID-19 increases day by day, we need to be more cautious and be well protected in handling the cases. It is known that young patients present with milder symptoms.

Spine surgeons need to follow certain protocols for patients who need surgical intervention on an emergency basis suspected with COVID-19. The risks and benefits have to be evaluated before any intervention is planned. Patients with positive or suspected COVID-19 need to be operated in a specially designed operating theatre by following certain measures to avoid infection to the staff and other patients.

Every health-care personal should be provided with a cap, N95 respirator mask, gloves, gown, and goggles, and anaesthetists can use powered air-purifying respirators. Surgical procedures need to be performed quickly and bring only selected equipment into the operation theatre to reduce exposure of surgical equipment, and after surgery, the equipment should be sanitized.

COVID-19 pandemic is growing abnormally, and it’s going to be a long chase. Similar to the measures we are taking in the practice of spine surgery, all other work activities need to be continuously reviewed. During this crisis time, it is important to educate the trainees about the situation by the senior spine surgeons and make sure they follow safety protocols.

The rise of COVID19 pandemic brought new challenges and has become a global threat. As an orthopaedic community, we should face the challenges with inventive techniques by adapting to the situation. Innovate your practice and serve your best to the patients who need us now more than ever.