Resource Utilization and Ethics of Urgent Orthopedic Spine Surgery During the COVID-19 Pandemic: A Case Report

Abstract

Introduction: Severe acute respiratory syndrome coronavirus-2 (SARs-CoV-2), also known as a coronavirus disease-19 (COVID-19), is a novel respiratory disease that has quickly surmounted to pandemic proportions. The purpose of this case report is to discuss the decision-making process, and resource utilization for spine cases that necessitate urgent surgical intervention in light of the COVID-19 pandemic. Case Presentation: A twenty-five-year-old Hispanic male presented to an emergency department in Long Island, New York on March 30th, 2020 with incomplete cauda equina with altered bladder function. An MRI revealed a moderately large central disc extrusion of L4/5 with deformation at the ventral thecal sac which resulted in severe spinal stenosis. Given displacement of immediately available resources, the patient required a transfer to an affiliate hospital with readily available operating room staff. Conclusion: From the time of initial presentation to the emergency room the patient was successfully transferred and brought to the operating room suite within eight hours. The patient underwent an L4/5 decompression and microdiscectomy for a large extruded disk herniation at L4/5 level without complications. With our healthcare system in the epicenter of the COVID-19 pandemic, we are in a unique environment exposed to the harsh characteristics of the surge. In parallel with similarly challenged organizations, our system quickly adapted and adopted various guidelines and committees to organize resource allocation. As demonstrated in this case, the displacement of immediately available resources, such as anesthesia staff, placed strain on the routine workings of surgical coordination. In normal times the decision-making in this case may seem straightforward; however, this case demonstrates the strains that the COVID-19 pandemic placed on our healthcare system especially with regards to surgical acuity, COVID-19 exposure risk and resource allocation. Keywords: Cauda equine; Spine; Medical ethics; COVID-19.