Why Dr. Ratnesh N. Mehra performed essential neurosurgery on a patient with COVID-19 & 10 steps his team took to stay safe


Michigan-based neurosurgeon Ratnesh N. Mehra, DO, performed the first neurosurgical procedure on a known COVID-19 positive patient in Detroit.

The patient arrived at Ascension St. John Hospital complaining of weakness after experiencing a fall. While in the ER, the patient had a COVID-19 test taken after reporting a prior cough and fever several days before. Given the patient's symptoms, Dr. Mehra decided to admit the patient and perform the work-up for his neurologic deficit, including a CT and MRI of the thoracic spine.

All the imaging equipment was appropriately sanitized in coordination with the radiology team, and the imaging showed thoracic spinal cord compression from a ventral mass.

"There was acute hyperintensity within the spinal cord at the level of compression, leading me to believe this was the problem," said Dr. Mehra. "I made a surgical plan for the following day. Around 11 p.m. the night before surgery, we received word that the COVID test was positive."

At that point, Dr. Mehra had a lengthy discussion with the hospital's OR staff and anesthesia team about the best way to proceed with the case. The patient was asymptomatic and hemodynamically stable without any respiratory distress, but was unable to walk due to issue with his spinal cord and may have experienced negative effects of not undergoing surgery.

"I believe as a hospital, community and society, we need to be prepared to treat COVID-19 patients for things other than COVID, because ultimately not every person who is positive will be severely ill, and yet they may have other illnesses and pathologies," said Dr. Mehra. "This gentleman has acute paraparesis and an inability to walk from thoracic cord compression; waiting to do his surgery was a non-option in my opinion, regardless of his COVID status."

The team devised a plan to maintain safety during the procedure, which included:

1. Intubating the patient in a negative pressure room before the patient arrived in the OR.

2. Everyone in the room with the patient wore an N95 mask and appropriate PPE.

3. All materials not necessary for the procedure were removed from the room before the patient entered.

4. Dr. Mehra was mindful of the electrocautery used and limited the smoke generated during the procedure.

5. The team used a special smoke evacuator on the field.

6. Dr. Mehra was mindful when using the power tools and drill to ensure bone dust and bodily fluids did not scatter in the air.

7. All equipment, including the lead Dr. Mehra wore during the case, was quarantined in the locked room.

8. After the case, nobody was able to enter the room until all surfaces and pieces of equipment were sterilized and sanitized, which was about three hours after the room was evacuated.

9. The team's PPE and scrubs worn during the case were discarded in biohazard bags.

10. The patient was in a negative pressure room during extubation and recovery before returning to his hospital room.

Dr. Mehra reports that the thoracic decompression and fusion with instrumentation was successful, and the patient was able to stand and ambulate after the surgery, which he could not do prior to the procedure. None of the team members present for the case have exhibited symptoms of the coronavirus after the procedure.


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