Systematic Reviews Open Access
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2022; 13(2): 193-200
Published online Feb 18, 2022. doi: 10.5312/wjo.v13.i2.193
COVID-19 pandemic: An update on the reaction attitude of the spine societies and their members worldwide
Alessandro Ramieri, Omar Alshafeei, Giuseppe Costanzo, SAIMLAL, Sapienza University, Rome 00100, Italy
Sokol Trungu, Antonino Raco, Massimo Miscusi, NESMOS, Sapienza University, Rome 00100, Italy
ORCID number: Alessandro Ramieri (0000-0002-3504-7381); Omar Alshafeei (0000-0003-2012-3350); Sokol Trungu (0000-0002-5087-6006); Antonino Raco (0000-0001-8401-9339); Giuseppe Costanzo (0000-0003-3304-7078); Massimo Miscusi (0000-0002-5101-9073).
Author contributions: Ramieri A and Miscusi M designed the research; Alshafeei O and Trungu S performed the research; Ramieri A and Alshafeei O analyzed the data; Alshafeei O and Ramieri A wrote the paper; Costanzo G and Raco A supervised the paper; all authors read and approved the final manuscript.
Conflict-of-interest statement: Alessandro Ramieri, Omar Alshafeei, Massimo Miscusi, Trungu Sokol, Antonino Raco, and Giuseppe Costanzo have nothing to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alessandro Ramieri, MD, PhD, Professor, Research Fellow, Surgeon, SAIMLAL, Sapienza University, Aldo Moro 5, Rome 00100, Italy. alexramieri@libero.it
Received: March 18, 2021
Peer-review started: March 18, 2021
First decision: July 18, 2021
Revised: August 1, 2021
Accepted: January 17, 2022
Article in press: January 17, 2022
Published online: February 18, 2022
Processing time: 336 Days and 18.3 Hours

Abstract
BACKGROUND

All surgical specialties have been influenced by the coronavirus disease 2019 (COVID-19) pandemic, and substantial changes have been determined in medical assistance, especially in elective surgery. Several spine societies have published recommendations to provide optimal care during this unique situation.

AIM

To discuss the recommendations by many spine societies for the management of spinal diseases during the COVID-19 pandemic.

METHODS

The present study was performed according to the PRISMA guidelines. A review of the MEDLINE database (PubMed – National Library of Medicine), Google, and Google Scholar was performed from March 2020 to date for articles published in the English Language.

RESULTS

Spine associations and societies worldwide were divided into three groups: Continental, specialty and country-based societies. A total of 27 spine associations were included in this review. There were eight major continental associations, but only one-third of these had published guidelines and recommendations on this topic. On the other hand, the specialty-based societies have not addressed the topic, except in two cases.

CONCLUSION

The national spine societies showed the deepest concern on this topic with several publications in scientific journals influenced by the local epidemiological severity. Contrarily, continental and specialty-based societies showed less interest in this topic.

Key Words: COVID-19; Pandemic; Spine surgery; Spine society; Guidelines; Recommendations

Core Tip: We designed a review to verify the reaction of the worldwide spine societies to the coronavirus disease 2019 pandemic. Twenty-seven associations were identified. Continental and specialty-based companies showed less reaction attitude than the regional scientific societies, probably due to the local epidemiological severity of the disease.



INTRODUCTION

With the start of the global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December of 2019, governments and healthcare providers were put on alert, fearing this novel virus that would ultimately lead to the declaration of a global pandemic on March 11.

This naturally resulted in healthcare systems around the world bracing for impact. The biggest hurdle that these systems expected was the need to accommodate a huge surge of patients requiring intensive care (early data suggested that 15%-35% of patients affected with the virus would need admission to the intensive care units). This load would effectively break a healthcare system.

The scientific community has continued to study SARS-CoV-2 to understand its pathogenicity while also trying to avoid the collapse of the healthcare structure and decrease the number of collateral deaths.

Several studies on the recommendations have been published by the major spine scientific societies worldwide[1-5]. The concluding observations of this review highlighted how these surgical scientific communities had promptly reacted to the emergency by issuing documents and guidelines. Here we review the literature concerning the release of documents, guidelines, or recommendations by spine societies, providing a comprehensive overview on these topics, thus providing a useful resource for spine surgeons worldwide.

MATERIALS AND METHODS

According to the PRISMA guidelines, a review of the MEDLINE database (PubMed - National Library of Medicine), Google, and Google scholar were performed on Monday, March 2, 2020, to date, for articles published in the English language. Search terms included: COVID-19 coronavirus AND pandemic AND spine AND surgery AND spine societies AND guidelines AND recommendations (Figure 1). We reviewed search results to assess the relevance of documents on these topics, including editorials, letters, and webpages. References were reviewed to locate other articles of interest.

Figure 1
Figure 1 PRISMA flow chart.
RESULTS

Twenty-eight associations and societies deal with the scientific aspects and interventional treatment of spine disorders. Spine associations and societies worldwide were divided into three groups: Continental (C) (n = 8), specialty (Sb) (n = 7), and country-based (Cb) (n = 12) societies. There were eight C-companies (Table 1), but only three [North America Spine Society (NASS), World Spine Column Society (WSCS), Asia Pacific Spine Society] published guidelines in international scientific journals. The Sb societies (Table 2) seem not to have addressed the topic. Only the Spine Intervention Society (SIS) published an online paper on their website with its guidelines. Furthermore, the AO spine website shows different strategies for maintaining internal research and training.

Table 1 List of the 8 spinal continental societies.
Continental societies
Links
World Spinal Column Societyhttps://www.worldspinalcolumn.org/
The Africa Spinal Cord Injury Networkhttp://www.afscin.org/afscin-4-2020
Asian Spinal Cord Networkhttps://ascon.info/
International Spinal Cord Societyhttps://www.iscos.org.uk/
North American Spine Societyhttps://www.spine.org/
European Spine Societyhttps://www.eurospine.org/
Asia Pacific Spine Societyhttps://www.apssonline.org/
Latin Americahttps://www.silaco.org/acerca
Table 2 List of the 7 specialty-based societies.
Specialty-based societies
Links
International Society for the Advancement of Spine Surgeryhttps://www.isass.org/
AOSpine https://aospine.aofoundation.org
Society for Minimally Invasive Spine Surgeryhttp://ismiss.com/1-0-Home.html
Scoliosis Research Societyhttps://www.srs.org/
Cervical Spine Research Societyhttps://www.csrs.org/
The International Society for the Study of the Lumbar Spinehttps://www.issls.org/
Spine Intervention Societyhttps://www.spineintervention.org/

All 12 Cb (Table 3) produced a publication: seven in scientific journals (French Spine Surgery Society), Saudi Spine Society (Saudi SS), Singapore Spine Society, Chinese Spine Society, The Japanese Society for Spine Surgery and Related Research, Egyptian Spine Association, Brazilian Spine Society) and the remaining five in websites or editorial documents (British Association of Spine Surgeons, Italian Spine Society, Association of Spine Surgeons of India, German Spine Society, Canadian Spine Society).

Table 3 List of the 12 country-based societies.
Country-based societies
Links
Italian Spine Societyhttps://www.gis-italia.org/
Saudi Spine Societyhttp://saudispine.org/
Association of Spine Surgeons of Indiahttp://assi.in
Singapore Spine Societyhttps://www.singaporespinesociety.org.sg/
German Spine Societyhttps://www.dwg.org/startseite/
French Spine Societyhttp://scfr.it
Egyptian Spine Associationhttps://www.facebook.com/Egyspine/
Chinese Spine Societyhttps://www.apssonline.org/
Iranian Spine Surgeryhttp://www.aicnss.com/
British Ass. Spine Surgeonshttps://spinesurgeons.ac.uk/
Canadian Spine Societyhttps://spinecanada.ca/
Brazilian Spine Societyhttp://www.plataformainterativa2.com/coluna/

The literature search yielded a sum of 28 articles that were relevant to spine surgery and coronavirus disease 2019 (COVID-19) (Table 4). We were able to identify four main topics developed in these papers.

Table 4 Selection of 28 articles from members of the spine societies.
Article title
Journal
Society/Country
Ref.
Triaging Spine Surgery in the COVID-19 EraJournal of Spinal Disorders and TechniquesAO Spine[1]
Triaging Spine Surgery and Treatment during the COVID-19 PandemicJournal of Orthopaedics and TraumatologyUSA[2]
French Spine Surgery Society guidelines for management of spinal surgeries during COVID-19 pandemicWorld Journal of Clinical CasesFrench[3]
Strategy for the Practice of Spine Oncological Surgery During the Covid-19 PandemicSpine Italy[6]
Spine Surgery and COVID-19: The Influence of Practice Type on Preparedness, Response, and Economic ImpactGlobal Spine Journal AO Spine[7]
Spine Surgery and COVID-19: Challenges and Strategies from the Front LinesJournal of Bone and Joint SurgerySingapore[8]
Spine Surgery and COVID-19: Early Experiences From SingaporeSpineSingapore[9]
COVID-19 Nonessential Surgery Restrictions and Spine Surgery: A German ExperienceSpineGermany[10]
The Impact of COVID-19 pandemic on Spine Surgeons: An Asia Pacific Spine Society (APSS) SurveySpineAsia Pacific [11]
COVID-19 and Spine Surgery: A Review and Evolving RecommendationsGlobal Spine JournalUSA[4]
Spine surgery in Atlantic Canada in the COVID-19 era: lessons learned so farSpineCanada[12]
Spine Surgery in Italy in the COVID-19 Era: Proposal for Assessing and Responding to the Regional State of EmergencyWorld NeurosurgeryItaly[13]
The Saudi Spine Society guidelines on spinal surgery during the COVID-19 pandemicJournal of Orthopaedics and ResearchSaudi[5]
Recommendations for resuming elective spine surgery in the COVID-19 eraBritish Journal of AnaesthesiologyUSA[14]
Principles for Managing Patients with Spinal Ailments in the Coronavirus Disease 2019 Era: What Do We Know So Far? An Evidence-Based, Narrative ReviewAsian Spine JournalIndia[15]
Medical care for spinal diseases during the COVID-19 pandemicClinicsBrazil[28]
The management of emergency spinal surgery during the COVID-19 pandemic in ItalyBone and Joint JournalItaly[16]
Scoring System to Triage Patients for Spine Surgery in the Setting of Limited Resources: Application to the Coronavirus Disease 2019 (COVID-19) Pandemic and BeyondWorld NeurosurgeryUSA[17]
Management of Spine Trauma in COVID-19 Pandemic: A Preliminary ReportArchives of Bone and Joint SurgeryIran[18]
Advice on Standardized Diagnosis and Treatment for Spinal Diseases during the Coronavirus Disease 2019 PandemicAsian Spine JournalChina[19]
The Role of Spine Surgeons in the Era of COVID-19 OutbreakNeurospineChina[20]
Addressing Coronavirus Disease 2019 in Spine Surgery: A Rapid National Consensus Using the Delphi Method via TeleconferenceAsian Spine JournalSingapore[21]
Adapting Policy Guidelines for Spine Surgeries During COVID-19 Pandemic in View of Evolving Evidences: An Early Experience From a Tertiary Care Teaching HospitalCureusIndia[22]
Addressing a national crisis: the spine hospital and department's response to the COVID-19 pandemic in New York CitySpine JournalUSA[23]
Essential Spine Surgery During the COVID-19 Pandemic: A Comprehensive Framework for Clinical Practice from a Specialty Orthopedic Hospital in New York CityHSS JournalUSA[24]
Impact of the COVID-19 pandemic on spinal surgery in SingaporeSingapore Medical JournalSingapore[25]
The Novel Corona Virus COVID-19 and Spinal Surgery Practice: Review and UpdatesThe Egyption Spine JournalEgypt[26]
Spine Surgery: Precautions and Strategies to Minimize Perioperative Risks Amid COVID-19 OutbreakSpine Surgery and Related ResearchJapan[27]
DISCUSSION

COVID-19, also known as acute respiratory disease, is an infectious respiratory disease caused by SARS-CoV-2. The first cases were identified in China, and after that, diffused around the world through respiratory droplets, with a high lethality rate. In this scenario, the COVID-19 pandemic has changed medical and surgical practices worldwide. Major scientific societies have issued guidelines and recommendations to optimize resources and ensure treatment without putting patients’ lives at risk. Urgent or non-deferrable emergency interventions were favoured, postponing those in the election but seeking their reactivation as soon as possible[6,10,12,14,18]. These changes have had a significant socio-economic impact. Specialty-based societies have also taken action, and in particular, the neurosurgical scientific community has promptly developed recommendations for managing patients with cranial or spinal pathologies[29]. A group of Italian neurosurgeons summarized these guidelines in a recent publication[30]. They discussed the “grey zone” left by the generalized guidelines regarding neurosurgery and how they should be acting to resume control.

Similarly, we wanted to verify the reaction of the worldwide spine societies to this emergency. This topic, to our knowledge, has not previously been addressed in the literature. Twenty-six associations, present on the web as companies or networks that deal with the interventional treatment of spinal pathologies, were identified. Three out of eight (37.5%) major continental companies (Saudi SS, NASS, WSCS) had issued guidelines in the form of scientific work in a journal or document. In particular, the NASS guidance, released on April 22, probably remains the most cited and applied document in subsequent scientific paper[21,26-28]: “……after reviewing the recommendations regarding procedures and treatments developed by the Centers for Medicare and Medicaid Services (CMS) and the American College of Surgeons (ACS), NASS convened a multidisciplinary task force of orthopaedic surgeons, neurosurgeons and PM&R/pain specialists to provide spine-care specific guidance for procedures” (see the entire document by the link in Table 2). The Asia Pacific society published a survey about the impact of a pandemic on surgical activity[11]: a total of 222 respondents from 19 countries completed the questionnaire. The mean reduction of clinic volume for all countries was 48.1%. Surgical theatres were closed, reduced, or limited to semi-emergency and emergency surgeries, and spine surgeons were moderately concerned about contracting COVID-19 during their clinical practice extremely concerned to transmit the disease to their family members.

Most Sb societies seem not to have addressed the topic. Only the SIS published a website document with its guidance. The AO spine website shows some corporate strategies for maintaining internal research and training. The greatest interest was from 12 Cb, with publications in journals, websites, or editorial documents. However, other regional societies are lacking. Four themes were seen recurring in our review of 28 articles relating to the new proposed guidelines and line of action. The highest recurring theme, which was seen in 100% of the articles, was the use of protective personal equipment and protocols to follow with COVID positive and COVID suspected patients to curb the spread and limit the transmission (Table 4).

The second was the use of a multidisciplinary panel to evaluate each patient admitted and the urgency[8,9,13]: doctors would have to decide based on the COVID burden imposed on the healthcare system and hospitals[15,17,19,24].

The third theme aimed to decrease the general activity of the healthcare system, increasing the number of hospital intensive care and departments able to treat infected people and the expected wave of patients. This topic was further discussed in detail the distinction of patients concerning their clinical picture and severity[20,22,23,25,27], given priority and urgency in treatment.

The fourth and last theme, which was seen only in seven articles, was the use of a team-based approach: each team could act independent, developing its own schedule and location, reducing work delay and decreasing the mixing of the different teams. A minimal effect on their department’s function was recorded. When viewing the Cb spine societies, we found different approaches to achieve similar objectives, ensuring a treatment activity on the most urgent patients or patients who cannot be postponed without increasing the risks of exposure or contact with the virus.

Most of the approaches were directed towards a “second phase”, which defines a period when the healthcare system is not overburdened by the pandemic. One point shared was the distinction and separation of patients based on clinical urgency and COVID status, resulting in the avoidance of unneeded risk. Checklists and forms, along with history taking and evaluation of the physician to both the patient’s condition and the system’s utilization, were extremely useful. The evaluation of the system was carried out by taking into consideration risks and resources. These were respectively weighted on the patient’s history and system capabilities, for example, by checking the ability of a healthcare facility to deal with an emergency situation. Surgery was chosen only when possible and needed, while a deferral was preferred to elective and low urgency cases. To guarantee patients during the hospital stay, hygiene, self-isolation rules, and restrictions on companionship rules were adopted. Fast-track recovery and online follow-up restricted the number of unneeded people in the hospital.

CONCLUSION

Only one-third of continental spine societies have issued recommendations. The international specialist companies have little addressed the topic, except for the SIS and partly the AO spine. Paradoxically, the national companies were more stimulated to issue their guidelines. The local epidemiological severity has likely influenced the reactive corporate attitude. Spine specialists at different levels realized the liability of not addressing spinal cases and the possible liabilities that could arise if taken up during a pandemic. Articles and online video conferences presented real-life scenarios that proved the gravity of the situation. The discussed guidelines and seminars showed their efficacy to control the spread of COVID-19 and the efficiency of the healthcare system. The points raised by the spine worldwide societies may not solve all issues related to spinal case management in the COVID era, but at least they have set forward a relevant ground to raise possible questions for the future’s sake, as well as the possibilities of reflecting upon these ideas on other similar areas of medicine. As a doctor of the Singaporean Spine Society commented, “We are all in the same storm, just different boats, and we should all work together to save each other”.

ARTICLE HIGHLIGHTS
Research background

During the second phase of the coronavirus disease 2019 (COVID-19) pandemic, some authors have felt the need to summarize and order data on the recommendations issued by the major surgical scientific societies in the world. The concluding observations of this review highlighted how these surgical scientific communities had promptly reacted to the emergency by issuing documents and guidelines. In particular, the neurosurgical scientific community has promptly developed recommendations for managing patients with cranial or spinal pathologies.

Research motivation

We designed a review of the literature concerning the release of documents, guidelines, or recommendations by the spine societies in the world, intending to offer an overview on these topics to which spine surgeons worldwide can easily refer.

Research objectives

This study aimed to discuss the recommendations by many spine societies for the management of spinal diseases during the COVID-19 pandemic.

Research methods

A review of the MEDLINE database according to the PRISMA guidelines.

Research results

We identified 28 associations present on the Internet as companies or networks that deal with the interventional treatment of spinal pathologies. We distinguished societies, associations, or networks worldwide into three groups. The literature search yielded a sum of 28 articles that were relevant to spine surgery and COVID-19.

Research conclusions

Only one-third of continental spine societies have issued recommendations. The international specialist companies have dealt little or nothing with the topic, except the SIS and partly AO spine. Paradoxically, the national companies were more stimulated to issue their guidelines. The local epidemiological severity has likely influenced the reactive corporate attitude.

Research perspectives

Articles and online video conferences presented real-life scenarios that proved the gravity of the situation. The discussed guidelines and seminars showed their efficacy to control the spread of COVID-19 and the efficiency of the healthcare system. The discussing points by the spine worldwide societies may not solve all issues related to spinal case management in the COVID era, but at least they have set forward a relevant ground to raise possible questions for the future’s sake, as well as the possibilities of reflecting upon these ideas on other similar areas of medicine.

Footnotes

Provenance and peer review: Invited article; Externally peer reviewed.

Peer-review model: Single blind

Specialty type: Orthopedics

Country/Territory of origin: Italy

Peer-review report’s scientific quality classification

Grade A (Excellent): 0

Grade B (Very good): 0

Grade C (Good): C, C

Grade D (Fair): 0

Grade E (Poor): 0

P-Reviewer: Jain V, Zelai NT S-Editor: Wang JL L-Editor: A P-Editor: Wang JL

References
1.  Donnally CJ 3rd, Shenoy K, Vaccaro AR, Schroeder GD, Kepler CK. Triaging Spine Surgery in the COVID-19 Era. Clin Spine Surg. 2020;33:129-130.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 49]  [Cited by in F6Publishing: 50]  [Article Influence: 12.5]  [Reference Citation Analysis (0)]
2.  Rizkalla JM, Hotchkiss W, Clavenna A, Dossett A, Syed IY. Triaging Spine Surgery and Treatment during the COVID-19 Pandemic. J Orthop. 2020;20:380-385.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 11]  [Cited by in F6Publishing: 12]  [Article Influence: 3.0]  [Reference Citation Analysis (0)]
3.  Prost S, Charles YP, Allain J, Barat JL, d'Astorg H, Delhaye M, Eap C, Zairi F, Guigui P, Ilharreborde B, Meyblum J, Le Huec JC, Lonjon N, Lot G, Hamel O, Riouallon G, Litrico S, Tropiano P, Blondel B; French Spine Surgery Society. French Spine Surgery Society guidelines for management of spinal surgeries during COVID-19 pandemic. World J Clin Cases. 2020;8:1756-1762.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in CrossRef: 12]  [Cited by in F6Publishing: 14]  [Article Influence: 3.5]  [Reference Citation Analysis (0)]
4.  Jain NS, Alluri RK, Schopler SS, Hah R, Wang JC. COVID-19 and Spine Surgery: A Review and Evolving Recommendations. Global Spine J. 2020;10:528-533.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 21]  [Cited by in F6Publishing: 18]  [Article Influence: 4.5]  [Reference Citation Analysis (0)]
5.  Alturkistany A, Abduljabbar FH, Alhelal F, Dajim NB, Khalifah S, Konbaz F, Aleissa S, Al-Habib A, Kattan M, Alqahtani Y, Alatassi R. The Saudi Spine Society guidelines on spinal surgery during the COVID-19 pandemic. J Orthop Surg Res. 2020;15:211.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 12]  [Article Influence: 3.0]  [Reference Citation Analysis (0)]
6.  Berjano P, Vanni D, Fariselli L, Cecchinato R, Boriani S. Strategy for the Practice of Spine Oncological Surgery During the Covid-19 Pandemic. Spine (Phila Pa 1976). 2020;45:1386-1394.  [PubMed]  [DOI]  [Cited in This Article: ]
7.  Weiner JA, Swiatek PR, Johnson DJ, Louie PK, Harada GK, McCarthy MH, Germscheid N, Cheung JPY, Neva MH, El-Sharkawi M, Valacco M, Sciubba DM, Chutkan NB, An HS, Samartzis D. Spine Surgery and COVID-19: The Influence of Practice Type on Preparedness, Response, and Economic Impact. Global Spine J. 2020;2192568220949183.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 8]  [Article Influence: 4.0]  [Reference Citation Analysis (0)]
8.  Soh TLT, Ho SWL, Yap WMQ, Oh JY. Spine Surgery and COVID-19: Challenges and Strategies from the Front Lines. J Bone Joint Surg Am. 2020;102:e56.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 16]  [Cited by in F6Publishing: 19]  [Article Influence: 4.8]  [Reference Citation Analysis (0)]
9.  Soh TLT, Ding BTK, Yap WMQ, Oh JY. Spine Surgery and COVID-19: Early Experiences From Singapore. Spine (Phila Pa 1976). 2020;45:786-788.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 8]  [Article Influence: 2.0]  [Reference Citation Analysis (0)]
10.  Mehta AI, Chiu RG. COVID-19 Nonessential Surgery Restrictions and Spine Surgery: A German Experience. Spine (Phila Pa 1976). 2020;45:942-943.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 25]  [Cited by in F6Publishing: 21]  [Article Influence: 5.3]  [Reference Citation Analysis (0)]
11.  Chan CYW, Chiu CK, Cheung JPY, Cheung PWH, Gani SMA, Kwan MK. The Impact of COVID-19 pandemic on Spine Surgeons: An Asia Pacific Spine Society (APSS) Survey. Spine (Phila Pa 1976). 2020;45:1285-1292.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 4]  [Article Influence: 1.0]  [Reference Citation Analysis (0)]
12.  El Helou A. Spine surgery in Atlantic Canada in the COVID-19 era: lessons learned so far. Spine J. 2020;20:1379-1380.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3]  [Cited by in F6Publishing: 4]  [Article Influence: 1.0]  [Reference Citation Analysis (0)]
13.  Rispoli R, Diamond ME, Balsano M, Cappelletto B. Spine Surgery in Italy in the COVID-19 Era: Proposal for Assessing and Responding to the Regional State of Emergency. World Neurosurg. 2021;145:e1-e6.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 6]  [Article Influence: 2.0]  [Reference Citation Analysis (0)]
14.  Wilson LA, Zhong H, Poeran J, Liu J, Memtsoudis SG. Recommendations for resuming elective spine surgery in the COVID-19 era. Br J Anaesth. 2020;125:e339-e341.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 5]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
15.  Viswanathan VK, Subramanian S, Rao AK. Principles for Managing Patients with Spinal Ailments in the Coronavirus Disease 2019 Era: What Do We Know So Far? Asian Spine J. 2020;14:572-580.  [PubMed]  [DOI]  [Cited in This Article: ]
16.  Giorgi PD, Villa F, Gallazzi E, Debernardi A, Schirò GR, Crisà FM, Talamonti G, D'Aliberti G. The management of emergency spinal surgery during the COVID-19 pandemic in Italy. Bone Joint J. 2020;102-B:671-676.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 44]  [Cited by in F6Publishing: 50]  [Article Influence: 12.5]  [Reference Citation Analysis (0)]
17.  Sciubba DM, Ehresman J, Pennington Z, Lubelski D, Feghali J, Bydon A, Chou D, Elder BD, Elsamadicy AA, Goodwin CR, Goodwin ML, Harrop J, Klineberg EO, Laufer I, Lo SL, Neuman BJ, Passias PG, Protopsaltis T, Shin JH, Theodore N, Witham TF, Benzel EC. Scoring System to Triage Patients for Spine Surgery in the Setting of Limited Resources: Application to the Coronavirus Disease 2019 (COVID-19) Pandemic and Beyond. World Neurosurg. 2020;140:e373-e380.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 13]  [Cited by in F6Publishing: 10]  [Article Influence: 2.5]  [Reference Citation Analysis (0)]
18.  Chehrassan M, Ebrahimpour A, Ghandhari H, Sanei Taheri M, Athari B, Sadighi M, Jafari KafiAbadi M, Karami A, Zali A. Management of Spine Trauma in COVID-19 Pandemic: A Preliminary Report. Arch Bone Jt Surg. 2020;8:270-276.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in F6Publishing: 2]  [Reference Citation Analysis (0)]
19.  Zou J, Yu H, Song D, Niu J, Yang H. Advice on Standardized Diagnosis and Treatment for Spinal Diseases during the Coronavirus Disease 2019 Pandemic. Asian Spine J. 2020;14:258-263.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 41]  [Cited by in F6Publishing: 40]  [Article Influence: 10.0]  [Reference Citation Analysis (0)]
20.  Wang B. The Role of Spine Surgeons in the Era of COVID-19 Outbreak. Neurospine. 2020;17:342-343.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Cited by in F6Publishing: 2]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
21.  Tan KA, Thadani VN, Chan D, Oh JY, Liu GK. Addressing Coronavirus Disease 2019 in Spine Surgery: A Rapid National Consensus Using the Delphi Method via Teleconference. Asian Spine J. 2020;14:373-381.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 6]  [Article Influence: 1.5]  [Reference Citation Analysis (0)]
22.  Verma V, Nagar M, Jain V, Santoshi JA, Dwivedi M, Behera P, Selvanayagam R, Pal D, Singh K. Adapting Policy Guidelines for Spine Surgeries During COVID-19 Pandemic in View of Evolving Evidences: An Early Experience From a Tertiary Care Teaching Hospital. Cureus. 2020;12:e9147.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Cited by in F6Publishing: 3]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
23.  Lombardi JM, Bottiglieri T, Desai N, Riew KD, Boddapati V, Weller M, Bourgois C, McChrystal S, Lehman RA. Addressing a national crisis: the spine hospital and department's response to the COVID-19 pandemic in New York City. Spine J. 2020;20:1367-1378.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3]  [Cited by in F6Publishing: 4]  [Article Influence: 1.0]  [Reference Citation Analysis (0)]
24.  Soffin EM, Reisener MJ, Sama AA, Beckman JD, Liguori GA, Lebl DR, Girardi FP, Cammisa FP, Hughes AP. Essential Spine Surgery During the COVID-19 Pandemic: A Comprehensive Framework for Clinical Practice from a Specialty Orthopedic Hospital in New York City. HSS J. 2020;1-7.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 6]  [Article Influence: 1.5]  [Reference Citation Analysis (0)]
25.  Tan BJ, Teo HLT, Loo WL, Dinesh SK. Impact of the COVID-19 pandemic on spinal surgery in Singapore. Singapore Med J. 2020;61:624-625.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3]  [Cited by in F6Publishing: 3]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
26.  Elkazaz MK, Abou-Madawi AM, Khattab MF, Elkhatib E, Alshatoury HA. The Novel Corona Virus COVID-19 and Spinal Surgery Practice: Review and Updates. Egy Spine J. 2020;34:2-12.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 1]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
27.  Wang TV, Ito M. Spine Surgery: Precautions and Strategies to Minimize Perioperative Risks Amid COVID-19 Outbreak. Spine Surg Relat Res. 2020;4:192-198.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 5]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
28.  Silva RTE, Cristante AF, Marcon RM, Barros-Filho TEP. Medical care for spinal diseases during the COVID-19 pandemic. Clinics (Sao Paulo). 2020;75:e1954.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 8]  [Article Influence: 2.0]  [Reference Citation Analysis (0)]
29.  Ricciardi L, Trungu S, Scerrati A, DE Bonis P, Miscusi M, Raco A. Neurosurgery at the time of COVID-19: how this pandemic infectious disease is influencing neurosurgical activities and patient management. J Neurosurg Sci. 2021;65:216-217.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 7]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
30.  Germanò A, Raffa G, Angileri FF, Cardali SM, Tomasello F. Coronavirus Disease 2019 (COVID-19) and Neurosurgery: Literature and Neurosurgical Societies Recommendations Update. World Neurosurg. 2020;139:e812-e817.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 46]  [Cited by in F6Publishing: 46]  [Article Influence: 11.5]  [Reference Citation Analysis (0)]