Five spine surgeons outline what types of surgeries and patients they are prioritizing as elective surgeries continue to ramp-up.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.
Next week's question: When do you see your practice returning to pre-pandemic patient volumes?
Please send responses to Alan Condon at email@example.com by 5 p.m. CDT Wednesday, June 10.
Note: The following responses were lightly edited for style and clarity.
Question: As elective surgeries resume, what patients and surgeries are you prioritizing? Why?
Jeffrey Wang, MD. USC Spine Center (Los Angeles): We have two priorities when it comes to patient surgeries: those who are younger, healthier and/or have short surgeries as outpatients and will likely not stay in the hospital or utilize inpatient resources. In addition, even throughout the crisis, we continued to perform necessary surgeries for serious conditions with progressive neurological deficits. As we move toward the resumption of elective surgeries, we are trying to prioritize the more serious cases first — those who need surgery on a more urgent basis due to neurological issues or intense pain.
Brian Gantwerker, MD. Craniospinal Center of Los Angeles: Patients that take precedence are those whose pain and discomfort are in crescendo. Patients with new or progressive neurological deficits are obviously top priority and should proceed without delay. We have been slow in doing instrumented cases for several reasons — chiefly being the reluctance of hospitals to allow us to schedule them. Subsequent delays have not harmed any patients, but certainly their time has come and should also be given priority.
Richard Kube, MD. Prairie Spine (Peoria, Ill.): At this time, we are scheduling everything. We continued to treat patients with neurologic compromise through the pandemic and now have a relatively good handle on the patients who had more elective procedures needed. Frankly, we have more of a backlog of patients getting diagnostic testing and medical workups for surgery. Our ability to add cases and catch-up has exceeded what other providers in the community have been able to do to help these patients along. Additionally, many patients stayed away during the early part of the quarantine, which also helped to prevent a tremendous backlog for us now.
Christian Zimmerman, MD. Saint Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): The most urgent of neurologically compromised patients have taken precedence in our hospital system as restrictions continue. Antecedent testing for COVID-19 clearance has created additional bottlenecks for early morning start times, but adjustments and efficiencies are developing around this mandate. As the system moves forward, so does the volume of surgical interactions. Patient fears of contact seem to be lessening in time.
Issada Thongtrangan, MD. Microspine (Phoenix): My first priority is the patients who have neurological deficits and risk having permanent nerve damage in addition to pain. I am extremely careful with high-risk patients who might need an ICU stay after surgery. Otherwise, all my surgical patients will need to have a negative COVID-19 test, because we have to protect our OR staff, healthcare personnel and ourselves.