Strategy for the Practice of Spine Oncological Surgery During the Covid-19 Pandemic.

Berjano, Pedro; Vanni, Daniele; Fariselli, Laura; Cecchinato, Riccardo; Boriani, Stefano

STUDY DESIGN Case series. OBJECTIVE For each of the most frequent clinical scenarios, the authors reached a consensus on how should be timing and indications be optimized to reduce risk while maintaining the expected outcomes under the COVID 19 pandemics. SUMMARY OF BACKGROUND DATA The organization of healthcare has been changed by the Covid-19 pandemic with a direct impact on Spine Oncology Surgery. Emergency surgery is still a priority, but in case of Spinal Tumors it should be better defined which conditions require emergency treatment. METHODS An expert panel with general spine surgeons, oncological spine surgeons and radiation oncologists was formed to analize the most frequent scenarios in spinal musculoskeletal oncology during COVID 19 pandemics. RESULTS Spine Metastases can be found incidentally during follow-up or can clinically occur by increasing pain, pathologic fracture and/or neurological symptoms. Primary Spine Tumors are much more rare and very rarely present with acute onset. The first step is to suspect this rare condition, in order to avoid to treat a primary tumor as it were a metastasis. Most complex surgery, like enbloc resection, associated with high morbidity and mortality rate for the treatment of low grade malignancy like Chordoma or Chondrosarcomas, if Intensive Care Unit availability is reduced, can be best delayed some weeks, as not impacting on prognosis, due to the slow growth rate of these conditions. The currently accepted protocols for Ewing's Sarcoma (ES) and Osteogenic Sarcoma (OGS) must be performed for local and systemic disease control. For ES, after the first courses of Chemotherapy, Radiotherapy can be selected instead of surgery, during Covid-19, to the end of the full course of chemotherapy. When delaying surgery (chemotherapy completed or toxicity), is essential to avoid contact between immune depressed and Covid-19 patients, during the hospital stay for surgery. CONCLUSIONS Even more than during normal times, a multidisciplinary approach is mandatory to share the decision to modify a treatment strategy. LEVEL OF EVIDENCE 5.