Response to the Coronavirus Disease 2019 Pandemic by the Spine Division at a Level-I Academic Referral Center

Graham J. DeKeyser, MD; Darrel S. Brodke, MD; Charles L. Saltzman, MD; Brandon D. Lawrence, MD


J Am Acad Orthop Surg. 2020;28(24):1003-1008. 

In This Article

Abstract and Introduction


Coronavirus disease 2019 (COVID-19) is a ubiquitous health concern and a global pandemic. In an effort to slow the disease spread and protect valuable healthcare resources, cessation of nonessential surgery, including many orthopaedic procedures, has become commonplace. This crisis has created a unique situation in the care of spine patients as we must balance the urgency of patient evaluation, surgical intervention, and continued training against the risk of disease exposure and resource management. The spine division of an orthopaedic surgery department has taken an active role in enacting protocol changes in anticipation of COVID-19. In the initial 4 weeks of the COVID-19 pandemic the spine division went from an average of 60.4 cases to 10 cases during the same timeframe. Clinic visits decreased from 417.4 to 322 with new patient visits decreasing from 28% to 20%. Three hundred eighteen of the 322 (98.7%) clinic visits were performed via telehealth. Although these changes have been forced upon us by necessity, we feel that our division and department will emerge in a more responsive, agile, and stronger state. As we look to the coming months and beyond, it will be important to continue to adapt to the changing landscape during unprecedented times.

The novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) was first identified in patients in the People's Republic of China in late December 2019.[1–3] As of April 10, 2010, this viral infection had been diagnosed in more than 1.5 million individuals worldwide and accounted for nearly 100,000 deaths. The World Health Organization has appropriately labeled this outbreak as a global health emergency, and this has led our society and global healthcare system into unprecedented territory. The public health focus has been on the suppression of disease transmission, preservation of valuable healthcare resources, and mitigation of the disease.[4–6]

The impact of this pandemic on spine surgery has forced practices to balance the urgency of clinical care against the conservation of healthcare resources and the suppression of diseases transmission. The orthopaedic spine division at our institution is a tertiary referral center serving a wide geographic area. The division consists of four fellowship-trained, subspecialized faculty with busy clinical practices, three physician assistants, two nurses, six medical assistants (MAs), two residents, and two fellows. The entire division has made rapid and dramatic adjustments to clinical practice and patient care in the midst of this healthcare crisis.

The spine division in concert with the department and our hospital system has rapidly pivoted in the face of coronavirus disease 2019 (COVID-19). These changes include halting all elective surgeries, creating a committee to appropriately triage urgent and emergent spine cases, changing operating room policies to protect surgical personnel, "platooning" residents in small groups to evaluate and round on patients, focusing on education through virtual platforms, delaying nonessential clinic visits, transitioning most clinic visits to a virtual platform, and participating in department and institutional leadership committees to communicate and adapt in the face of rapid changes and obstacles.

The purpose of this review is to describe the changes implemented by the spine division at an academic, tertiary care center in response to the COVID-19 pandemic.