# Increase in (semi-) acute non-instrumented lumbar spine surgeries during the COVID-19 pandemic

## TL;DR

During the COVID-19 pandemic, fewer elective lumbar spine surgeries were performed, but there was a sharp rise in urgent surgeries due to severe symptoms.

## Contribution

This study quantifies the shift from elective to urgent lumbar spine surgeries during the pandemic and identifies the reasons for the increase.

## Key findings

- Spinal surgeries dropped by 38.7% during the pandemic.
- Urgent surgeries rose by 300%, mainly due to severe radiculopathy.
- Better outcomes and fewer complications were observed in urgent surgeries.

## Abstract

Due to the COVID-19 pandemic healthcare resources were reallocated, thereby reducing elective surgery capacity. An increase in acute surgeries due to postponed elective surgeries was expected. Since elective lumbar spine surgery for degenerative indications was among the cancelled or postponed surgical interventions, we hypothesized that the number of acute and semi-acute surgeries would increase during the pandemic.

What was the effect of the COVID-19 pandemic on the number of (semi-)acute lumbar spinal surgeries?

This prospective cohort study included patients who underwent non-instrumented degenerative lumbar spine surgery, i.e. interlaminar decompression, laminectomy or lumbar microdiscectomy. We distinguished a pre-COVID cohort (between 01.03.2019 and 29.02.2020) and a COVID-cohort (between 01.03.2020 and 28.02.2021).

We included 313 patients in the pre-COVID cohort and 194 in the COVID-cohort, reflecting a decline of 38.7 %. The number of (semi-)acute indications increased with 300 % in the COVID-cohort, which was mainly the result of more surgeries for severe and intractable radiculopathy. We also noted an increase in good clinical outcome and a decline in complications in the COVID-cohort.

The number of elective degenerative lumbar spine surgeries declined due to the COVID-19 pandemic, while the rate of (semi)-acute lumbar spinal surgeries increased strongly. The latter may be due to altered patients’ clinical presentations and surgical decision making in times of severe health care scarcity of elective surgical care.

•The number of spinal surgeries declined with 38.7 % during the COVID-19 pandemic.•(Semi-)acute spinal surgeries increased with 300 % in the COVID versus the pre-COVID cohort.•More semi-acute lumbar spinal surgeries occurred due to severe, intractable radiculopathy.•Increased rate of good surgical outcome and reduced complication rate during the COVID-pandemic.

The number of spinal surgeries declined with 38.7 % during the COVID-19 pandemic.

(Semi-)acute spinal surgeries increased with 300 % in the COVID versus the pre-COVID cohort.

More semi-acute lumbar spinal surgeries occurred due to severe, intractable radiculopathy.

Increased rate of good surgical outcome and reduced complication rate during the COVID-pandemic.