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

Materials and Methods

An expert panel composed of three orthopedic spine surgeons (S.B. with life-long dedication to oncological spine surgery, P.B. with 20-year experience in complex spine surgery, and R.C. with 10-year experience in complex spine and spine tumor surgery), and one radiation oncologist (L.F.) was formed to analyze the most frequent scenarios in spinal musculoskeletal oncology and to reach consensus on how timing and indications should be optimized to reduce risk while maintaining the expected outcomes under the Covid-19 pandemics. One additional participant D.V. participated preparing the clinical scenarios and collecting the consensus. No additional experts were invited to form the panel due to the urgent need to develop local guidelines in a short time.

Two authors (S.B. and P.B.) categorized the most frequent clinical scenarios requiring clinical decisions in spine oncology. When appropriate, specific tumor types were described for each scenario.

The following scenarios were discussed:

  1. Undiagnosed spinal tumors.

  2. Spinal metastases.

  3. Primitive spinal benign tumors.

  4. Primitive spinal malignant tumors.

For each clinical scenario the members of the panel held a discussion session. Specific questions for each scenario were:

  • What strategy may benefit the patient by reducing perioperative risk during the Covid-19 epidemics?

  • Is there a strategy that can provide appropriate treatment while avoiding or minimizing surgery?

  • Is there a strategy that can provide appropriate management while delaying surgery?

  • For the specific scenario under what conditions surgery should be performed independently of the Covid-19 epidemics status?

The members of the panel were asked for references in support of their proposals. After discussion all the recommendations were taken by unanimity. Any proposal that did not meet unanimous consensus was rejected.

Strength of recommendations was categorized following the classification of the NASS guidelines taskforce (REFERENCE) as follows:

  1. A: Good evidence (Level I studies with consistent finding) for recommending

  2. B: Fair evidence (Level II or III studies with consistent findings) for recommending

  3. C: Poor-quality evidence (Level IV or V studies) for recommending

  4. I: Insufficient or conflicting evidence not allowing a recommendation

Levels of evidence were categorized following the same source.