Strategy for the Practice of Spine Oncological Surgery During the Covid-19 Pandemic

Pedro Berjano, MD, PhD; Daniele Vanni, MD; Laura Fariselli, MD; Riccardo Cecchinato, MD; Stefano Boriani, MD


Spine. 2020;45(19):1386-1394. 

In This Article

Abstract and Introduction


Study Design: Case series.

Objective: For each of the most frequent clinical scenarios, the authors reached a consensus on how should be timing and indications be optimized to reduce risk while maintaining the expected outcomes under the Covid-19 pandemics.

Summary of Background Data: The organization of health care has been changed by the Covid-19 pandemic with a direct impact on Spine Oncology Surgery. Emergency surgery is still a priority, but in case of spinal tumors it should be better defined which conditions require emergency treatment.

Methods: An expert panel with general spine surgeons, oncological spine surgeons, and radiation oncologists was formed to analyze the most frequent scenarios in spinal musculoskeletal oncology during Covid-19 pandemics.

Results: Spine metastases can be found incidentally during follow-up or can clinically occur by increasing pain, pathologic fracture, and/or neurological symptoms. Primary spine tumors are much more rare and very rarely present with acute onset. The first step is to suspect this rare condition, to avoid to treat a primary tumor as it were a metastasis. Most complex surgery, like en bloc resection, associated with high morbidity and mortality rate for the treatment of low grade malignancy like chordoma or chondrosarcomas, if intensive care unit availability is reduced, can be best delayed some weeks, as not impacting on prognosis, due to the slow growth rate of these conditions. The currently accepted protocols for Ewing sarcoma (ES) and osteogenic sarcoma must be performed for local and systemic disease control. For ES, after the first courses of chemotherapy, radiotherapy can be selected instead of surgery, during Covid-19, to the end of the full course of chemotherapy. In immunocompromised patients, (treated by chemotherapy), it is necessary to avoid contact with affected or exposed people.

Conclusion: Even more than during normal times, a multidisciplinary approach is mandatory to share the decision to modify a treatment strategy.

Level of Evidence: 5


Patient's safety is a priority in surgery. In spine oncological surgery, reducing the chance of life-threatening complications is critical. Onset of Covid-19 pneumonia in the perioperative period is a potential life-threat.[1,2] During such an unexpected situation like the Covid-19 pandemic, it becomes mandatory to modify health care priorities and treatment paradigms for most disease. Spine tumors' surgery frequently requires long-term procedures with need of blood transfusions and bed occupancy in ICU. The approach to bone tumors of the spine is complex, divided into two major branches (metastases and primary tumors) including opposite treatment strategies. The treatment of bone metastases aims to delete or reduce pain, stabilize pathologic fracture, prevent or treat neurological consequences of cord compression,[3,4] only rarely resecting completely the tumor.[5] Conversely the treatment of primary tumors must be curative, based on diagnosis and oncological staging.[6,7] In the current stage of the pandemic, the prevalence of virus vectors among the hospital population (patients and workers) is probably higher than that in the general population.[8] The purpose of this article is to propose specific strategies to optimize the management and outcomes of patients presenting with bone tumors of the spine.