Patrick Fransen and Jean Taylor, orthopedic surgeons specialising in treatments of the spine at Monaco’s IM2S, have issued a statement with the title ‘Impact of the COVID-19 epidemic on the management of spinal pathology’ that suggests that many patients have suffered in various ways as a result of fears about catching coronavirus. (The statement is reprinted here in full in English)
“From the start of the Covid 19 epidemic, the number of patients requiring hospitalisation, whether in intensive care or in conventional care units, increased rapidly which in some countries caused a sudden and unexpected saturation of hospitals and systems. health. Hospitals have had to define treatment protocols and routes, to separate infected patients and those who are not. This made it possible to guarantee a diagnosis and a secure therapeutic care for the patients and to limit the risks of contamination of the care staff. The instruction relayed by the authorities was also that all non-urgent surgical activities should be suspended,” the authors write.
“The spinal surgery departments therefore had to set up a triage system, dividing the spinal pathology into elective, semi-urgent and urgent pathology. Elective pathologies, such as spinal deformities or narrow lumbar and cervical canals without neurological deficit, and surgical treatments for chronic pain, have almost systematically been postponed. Semi-urgent conditions were assessed on a case-by-case basis to determine the best timing for the surgery. These were usually progressive vertebral fractures, pain associated with a herniated cervical or lumbar disc, or rapidly progressing cervical or thoracic myelopathy. Finally, certain pathologies continued to be operated on as an immediate emergency, such as acute compressions of the spinal cord and nerve roots on infection, hematoma, tumour, fracture or herniated disc, causing rapidly progressive paralysis or medically uncontrollable pain.
“Like our Italian colleagues, we not only quickly observed a significant drop in the management of degenerative spinal pathologies, which was logical since we advised to postpone them, but in addition to that, confinement also seemed (to) cause a reduction in the absolute number of spinal pathologies treated from all causes. The reason is that the patient postpones, outside of medical supervision, pathologies that he considered non-urgent, and a preference for conservative management that does not require hospitalisation. Finally, we add the strong reduction in all trauma related to work or mobility.
“At the end of confinement, the resumption of activity was extremely gradual, no doubt following a fear of the population to return to a medical environment. This has led to the management of surgical pathologies with an unusually long delay. This may have consequences in terms of recovery from these pathologies which treated late, could lead to incomplete recovery.
“Currently, we have not yet returned to a completely normal situation. We are probably still gradually welcoming some of the patients who were not treated during the lockdown. The apprehension of going physically to a hospital environment remains present, maintained by unprecedented media coverage of the pandemic. Finally, it is likely that we are moving towards a different expression of the pain of spinal pathologies, to be related to a stress of the population clearly greater than usual, linked both by the fear of an infection by the Covid, but also to the consequences of the measures taken around the world to avoid them.”
IM2S is an orthopedic medico-surgical clinic in Monaco, which brings together specialists in all osteo-articular pathologies. It is particularly recognised for its expertise in sports medicine.
PHOTO: The IM2S Clinic in Monaco