The Impact of COVID-19 Pandemic on Spine Surgeons

An Asia Pacific Spine Society (APSS) Survey

Chris Yin Wei Chan, MD, MSOrth; Chee Kidd Chiu, MBBS, MSOrth; Jason Pui Yin Cheung, MBBS, MMedSc, MS, PDipMDPath, MD, FHKAM(orth), FRCSEd(orth), FHKCOS; Prudence Wing Hang Cheung, BDSc(Hons); Siti Mariam Abd Gani, BSc; Mun Keong Kwan, MBBS, MSOrth


Spine. 2020;45(18):1285-1292. 

In This Article

Abstract and Introduction


Study Design: Cross-sectional survey.

Objective: The aim of this study was to investigate the impact of COVID-19 pandemic on the clinical practices of spine surgeons within the Asia Pacific region.

Summary of Background Data: COVID-19 pandemic had changed spine surgeons' clinical practices and their concerns toward personal and family risk of infection.

Methods: This cross-sectional survey was carried out from May 4, 2020 to June 4, 2020. The questionnaire was administered using REDCAP. The online questionnaire includes four sections. First section includes surgeon's demographics, background, type of clinical practice, and status of pandemic in their country. Second section includes volume and the type of spine surgery practice before the COVID pandemic. Third section includes changes of clinical practice during the pandemic and the last section was regarding their concern on COVID transmission.

Results: Total of 222 respondents from 19 countries completed the questionnaire. During the pandemic, 92.3% of the respondents felt their clinical practice was affected. 58.5% respondents reported reduced outpatient clinic hours and 74.6% respondents reported reduced operation theatre hours due to the enforcement by the hospital administration. The mean reduction of clinic volume for all countries was 48.1%. There was a significant reduction in the number of surgeries performed in Japan, Malaysia, India, Philippines, and South Korea. This was due to reduced patient load. More than 60% of respondents were worried being infected by COVID-19 virus and >68% were worried of transmission to their family members.

Conclusion: COVID-19 pandemic has significantly affected the clinical and surgical practice of spine surgeons in the Asia Pacific region. Clinics were closed or the practice hours reduced. Similarly, surgical theaters were closed, reduced, or limited to semi-emergency and emergency surgeries. Spine surgeons were moderately concerned of contracting COVID-19 during their clinical practice but were extremely concerned to transmit this disease to their family members.

Level of Evidence: 4.


COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. It was first identified in December 2019. This infection caused symptoms that ranged from mild cough, sore throat, and fever to severe viral pneumonia with multiple organ failure. On March 11, 2020, the World Health Organization (WHO) declared the outbreak a pandemic.[1] With large numbers of patients affected in the Asia Pacific region such as China, Japan, Singapore, and India, most governments had imposed movement restriction measures in an attempt to break the transmission chain of this disease.[2,3]

The disease itself coupled with these measures had led to a profound worldwide social and economic impact.[4,5] In China, industrial output fell 13.5% in January and February, compared to the year 2019. Year-on-year, fixed asset investment fell 24.5%, whereas private sector investment fell 26.4%. Retail sales reduced to 20.5% and the unemployment rate rose to 6.2% in February, compared to 5.2% in December 2019.[5] According to International Monetary Fund organization, the current economic impact is expected to be as severe as that of the global financial crisis of 2009.[6]

For medical professionals, the large volume of patients threatens to overwhelm the resources available.[7,8] The strain on medical resources included the number of personnel required to screen and/or treat suspected COVID-19 patients, hospital inventories such as ventilators, and consumable products, in particular personal protective equipment (PPE) for health care workers.[9,10] Although most spine surgeons are not directly involved in the treatment of COVID-19 patients during this pandemic, the burden to institutional resources would influence their clinical practices. In other medical disciplines, numerous reports on the effect of this pandemic on their patients or their practices had been published in recent months.[11–13]

Therefore, the aim of this research was to investigate the impact of COVID-19 pandemic on the clinical practices of spine surgeons within the Asia Pacific region. Other objectives of this study were to understand their concerns toward personal and family safety when carrying out their daily clinical practices.