How was spinal surgery activity maintained during the COVID-19 pandemic? Results of a French multicenter observational study.

INTRODUCTION: The French Society of Spinal Surgery (SFCR) offered guidelines during the COVID pandemic. The objective of this work was to report the organization and activity in spinal surgery during the first month of confinement across 6 centers in France. The secondary objective was to monitor the adequacy of our practices within the SFCR guidelines. MATERIAL AND METHODS: This prospective multicenter observational study reported spinal surgery activity in each institution from March 16 to April 16, 2020, as well as the organizational changes applied. Surgical activity was compared to that of the same period in 2019 in each center and evaluated according to the SFCR guidelines, in order to control the adequacy of our practices during a pandemic period. RESULTS: During the peak of the epidemic, 246 patients including 6 COVID-positive patients were treated surgically. The most significant drops in activity were found in Strasbourg (-81.5%) and Paris (-65%), regions in which the health situation was the most critical, but also in Bordeaux (-75%) despite less viral circulation. Operating rooms functioned at 20 to 50% of their normal capacity. There was a significant reduction in procedures for degenerative spine conditions or deformities, in line with the SFCR guidelines. CONCLUSION: Maintaining spinal surgery is possible and desirable, even in times of health crisis. The indications must be considered according to the emergency criteria developed by learned societies and adapted to health developments and to the technical possibilities of treatment, by center. LEVEL OF PROOF: IV.

Comment l’activité chirurgicale rachidienne a été maintenue pendant la pandémie COVID 19? Résultats d’une étude observationnelle multicentrique française How was spinal surgery activity maintained during the COVID-19 pandemic? Results of a French multicenter observational study

Résumé Introduction: La Société Française de Chirurgie Rachidienne (SFCR) a des recommandations pendant la pandémie COVID. L’objectif de ce travail est de rapporter l’organisation et l’activité en chirurgie rachidienne pendant le premier mois de confinement de 6 centres en France. L’objectif secondaire est de contrôler l’adéquation de nos pratiques avec les recommandations de la SFCR. Matériel et méthode: Il s’agit d’une étude observationnelle multicentrique prospective entre le 16 Mars et le 16 Avril 2020 rapportant l’activité chirurgicale rachidienne dans chaque institution, ainsi que les modifications organisationnelles appliquées. L’activité chirurgicale était comparée à celle de la même période en 2019 dans chaque centre et évaluée en fonction des recommandations de la SCFR afin de contrôler l’adéquation de nos pratiques en période de pandémie. Résultats: Pendant le pic de l’épidémie 246 patients dont 6 patients COVID+ ont été pris en charge chirurgicalement. Les baisses d’activité les plus importantes étaient retrouvées à Strasbourg (-81,5%) et à Paris (-65%), régions dans lesquelles la situation sanitaire était la plus critique, mais également à Bordeaux (-75%) malgré une circulation virale moins importante. Un fonctionnement de 20 à 50% des capacités normales des salles opératoires était noté. La diminution importante des procédures pour rachis dégénératif ou déformations était en adéquation avec les recommandations de la SFCR. Conclusion: Le maintien d’une activité chirurgicale rachidienne est possible et souhaitable même en période de crise sanitaire. Les indications doivent être réfléchies selon les critères d’urgences élaborés par les sociétés savantes et adaptées à l’évolution sanitaire et aux possibilités techniques de prise en charge par centre. Niveau de preuve: IV.

COVID-19 induced mesenteric venous infarction.

We present a rare case of mesenteric venous infarction in a 36-year-old man due to coronavirus disease-19 (COVID-19). Although COVID-19 usually presents with respiratory disease, multi-system manifestations are increasingly reported. Coagulopathy manifestations are also reported on imaging, including in vascular thrombosis, embolus, and organ infarction. Because the clinical variables poorly predict or suspect coagulopathy and its complications, it is important to be aware of imaging manifestations of coagulopathy complications of COVID-19.

Adapting palliative radiation therapy for bone metastases during the Covid-19 pandemic: GEMO position paper.

The current health crisis caused by COVID-19 is a challenge for oncology treatment, especially when it comes to radiotherapy. Cancer patients are already known to be very fragile and COVID-19 brings about the risk of severe respiratory complications. In order to treat patients safely while protecting medical teams, the entire health care system must optimize the way it approaches prevention and treatment at a time when social distancing is key to stemming this pandemic. All indications and treatment modalities must be re-discussed. This is particularly the case for radiotherapy of bone metastases for which it is possible to reduce the number of sessions, the frequency of transport and the complexity of treatments. These changes will have to be discussed according to the organization of each radiotherapy department and the health situation, while medical teams must remain vigilant about the risks of complications of bone metastases, particularly spinal metastases. In this short piece, the members of the GEMO (the European Study Group of Bone Metastases) offer a number of recommendations to achieve the above objectives, both in general and in relation to five of the most common situations on radiation therapy for bone metastases.