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


Correct histological diagnosis and understanding of the biology of specific tumors provides a solid foundation to guide the treatment. During Covid-19 pandemics avoidance or delay of surgery and reduction of surgical aggressiveness enhance patients' safety and must be pursued. Recommendations for specific tumor types based on level of evidence II-III can assist decision-making in this respect.

This study comes with limitations. The composition of the panel was limited to a small number of members from two institutions. They included spinal oncological surgeons and a radiation therapy oncologist. Inclusion of more clinical disciplines (medical oncologist, neurological surgeon, radiologist) would have added validity to the conclusions. Still, the panel includes specialists with decades of experience in a multidisciplinary environment, which may have reduced the bias in their opinions and evaluation of data in the literature. A second limitation is that the conclusions of the panel might reflect clinical settings that might not be translatable to other countries or contexts. Still, the authors made attempts to keep their suggestions general enough to make them applicable in a wide range of clinical settings. A third limitation is that formally developed and validated questionnaires and a formal system for vote were not used. The decisions of the panel were based on unanimity. Proposals not approved by all the members were not included in the recommendations. These limitations (reduced number of panelists, regionally represented specialists and agile discussion process) were constraints caused by the need to develop guidelines in a short time interval for their clinical application.

In conclusion (Table 1), histological diagnosis following biopsy provides an opportunity to reduce the exposure of patients to unneeded risk. Spinal metastases with high risk of fractures should be addressed surgically, favoring less invasive procedures. Patients with benign tumors needing surgery may be delayed. Specific benign tumors (ABC, GCT) can benefit from nonsurgical options. Surgery for low grade malignant tumors in the absence of neurological damage can be safely delayed in most cases. Regarding high-grade malignant tumors, surgical delay based on neoadjuvant chemotherapy and radiation therapy may be feasible in cases of ES. Osteogenic sarcoma can in some cases be delayed during neoadjuvant chemotherapy but once it is completed should be managed with en bloc resection without delay.