Surgical spine surgeries
The SSS recommends that spine surgery candidates be categorized into three categories: category A (immediate), category B (urgent), and category C (elective). These categories are defined as follows:
Category A (immediate) includes patients who need immediate surgical intervention within 24 h. To fall in this category, patients must have clinical or radiological evidence of neurological deficit or structural instability secondary to traumatic, infectious, degenerative, or oncological conditions.
Category B (urgent) includes patients who require urgent surgical intervention, generally within 72 h. Such patients will have imminent neurological deficit or structural instability due to traumatic, infectious, degenerative, or oncological conditions, which may lead to deterioration of their functional status. It also includes patients with infectious or malignant conditions of the spine even in the absence of neurological deficit or structural instability, who need close monitoring as they might develop a need for immediate surgical intervention.
Category C (elective) includes patients suffering from chronic or subacute spine disorders, other than oncological or infectious diseases, who may eventually need surgical intervention. For patients to fall in this category, they must not display any clinical or radiological evidence of imminent neurological or structural instability, which includes cases of spine trauma that could be treated conservatively.
For patients in categories A and B, surgical procedures should be carried out as usual, without any delay. Because these procedures are non-deferrable, and any delay may have a permanent negative effect on the functional outcome or may be life-threatening. Alternatively, other less invasive options may be considered depending on hospital resources and patient status. Each patient should be provided with a full explanation about symptoms of COVID-19 and its identification. Use of personal protective equipment is recommended by the Centers for Disease Control for every operative procedure performed on a patient with confirmed COVID-19 infection or a patient where there is suspicion for infection . Finally, patients should sign the consent after knowing the risk of undergoing the surgery in this situation.
For patients in category C, we strongly recommend postponing the procedure unless the patient progresses to category A or B. Nevertheless, the risk of neurologic deterioration and quality of life must be considered, and we recommend that surgeons repeatedly assess the risk–benefit ratio of surgery. Patients must fully understand that the postponement of surgery is in their best interest, as well as that of the medical staff.