Spinal Surgery in National Emergencies: Lessons from a Pandemic Era of Postponed and Ultimately Cancelled Operations.

Background: The impact of the coronavirus disease-19 (COVID-19) pandemic on nationwide surgical spine care has not been investigated in a multicentre setting yet, despite its relevance to planning and preparedness for future national emergencies. It was hypothesized that the pandemic would be associated with a reduction in the number of surgical spine procedures performed, more pronounced in certain categories of procedures. Methods: The German Spine Registry was utilized and surgical cases were selected. Two groups were formed: the 'PRE-pandemic' group was composed of admissions before 01.01.2020, whereas admissions between 01.01.2020 and 31.12.2020 were assigned to the 'PANdemic' group. The number of interventions across spinal pathology categories was compared between groups. Additionally, the impact of specific pandemic waves was analysed. Results: A total of 144,927 cases were included. Annual interventions per institution were higher in the PRE-pandemic group compared to the PANdemic group (49064 vs. 47179, respectively). Similar monthly surgical volume dynamics were seen in 2018 and 2019, while an altered pattern occurred during the COVID-19 year. The most prominent decrease in surgeries was seen in trauma, degenerative diseases and deformity patients. No compensatory increase in surgical volume occurred. Conclusions: This study shows that the COVID-19 pandemic significantly reduced spinal surgery volumes in Germany, with suboptimal care distribution across patient groups. No compensatory increase in surgical volume was seen and this implies that a significant number of delayed interventions were ultimately postponed. These findings should be used to improve preparedness and establish protocols to optimally ensure continuity of spine care for all pathologies in future national emergencies.