COVID-19 & Back Surgery: 6 Essential Things You Need to Know
A growing number of states and cities across the country are restricting residents’ movements in order to help slow the spread of the coronavirus that causes COVID-19. This includes the closure of schools, public buildings, bars, restaurants, and other non-essential businesses.
These public orders are not lockdowns. However, most require people to stay inside as much as possible, except for essential activities such as buying groceries or other supplies, picking up medicines, exercising, or walking your dog.
So what about your back surgery or other spine-related procedure? We talked to an expert to find out which appointments to keep and which ones to cancel during the coronavirus pandemic.
Keep in mind that because the COVID-19 situation is rapidly changing, these recommendations can change at any time. If in doubt, call your doctor’s office and ask if your surgery or visit is something that can be postponed.
Avoid routine appointments
Everyone in the country is being asked to practice social distancing in order to curb the spread of the coronavirus. This includes staying at least six feet away from people who aren’t in your immediate family. This not only reduces your risk of contracting the coronavirus, but it also protects health care providers. So if it’s a routine, non-urgent visit to your doctor, chiropractor or physical therapist, do not go.
“In general, if the patients are being assessed for a chronic problem — one that has been going on for several months or years — it is probably better to arrange for a telemedicine visit or postpone the appointment if the symptoms are mild and manageable,” says Dr. Nikhil R. Nayak, a neurosurgeon with Virginia Neurosurgeons in Arlington, Virginia.
Depending on where you live, your doctor’s office may have already proactively canceled these visits. They might also be offering virtual visits by telephone or video call.
“In our practice, and most practices in our area, we have largely switched to telemedicine services including phone calls and video conferences,” says Nayak. “Overall, these visits have been working fairly well, especially with follow-up visits.”
A doctor can easily ask about a person’s symptoms and medical history during a phone or video call. This also works for many post-surgical follow-up visits. Patients can even take a close-up picture of their wound and send it to their doctor through a secure app.
Nayak says there are some cases, though, where a face-to-face visit is still needed, such as:
- When a surgical wound can’t be evaluated properly over video or with pictures sent by the patient.
- If a patient has staples or visible sutures that need to be removed.
- If a patient with back or neck pain has any “red flags,” including fever, bowel or bladder dysfunction, a history of cancer, or weakness or numbness in the arms, legs or other parts of the body.
- If a telemedicine visits suggests that a person will likely need surgery that can’t be postponed.
If in doubt, call your doctor’s office and ask to speak to a healthcare provider.
Postpone elective surgeries
The Centers for Medicare & Medicaid Services released guidelines recommending that non-essential surgeries and medical procedures be postponed until the pandemic ends. Nayak says most hospitals are generally following these recommendations.
So what is an elective surgery? Basically, it is any medical procedure that isn’t medically necessary at that moment.
The CMS guidelines break down surgeries and procedures into different “tiers” based on how urgent they are and the patient’s health. They also take into account other factors such as cases of COVID-19 in the area and the availability of hospital beds and supplies.
“Most spine surgery is technically elective, even if there are neurological signs and symptoms,” says Nayak, “as it is the patient's choice whether to undergo surgery.”
There are exceptions, he says. For example, if a person has a neurological deficit such as dropping of the foot and an MRI shows a herniated disc, early surgery might offer the best chance of a recovery. If in doubt, talk to your doctor.
“Patients need to have a frank conversation with their surgeon on whether or not these surgeries can wait,” says Nayak. “My suspicion is that many of them can be safely postponed.”
Why non-essential procedures are being canceled
Limiting non-essential procedures helps reduce the spread of the coronavirus by allowing people to stay at home — which protects health care providers and other patients.
“Because COVID-19 virus can spread even when an infected person has no symptoms, any health care worker treating any patient is at risk. That includes patients receiving elective surgery,” says Dr. Mary Dale Peterson, president of the American Society of Anesthesiologists and executive vice president and chief operating officer of Driscoll Health System in Corpus Christi, Texas.
Some reports suggest that about half of people infected with the virus that causes COVID-19 don’t have any symptoms. Scientists aren’t certain how easily these people can infect others. However, until we know for sure, public health officials recommend that people continue practicing social distancing. Especially since there is currently no vaccine to protect people against the coronavirus.
Peterson says elective surgeries are also being canceled to free up healthcare resources needed to treat the large numbers of patients with COVID-19, many of whom will require intensive support.
“To care for these patients, resources used for elective surgeries need to be reallocated, including personal protective equipment (PPE) and anesthesia gas machines that can be converted to ventilators,” she says.
This also frees up anesthesiologists and other health care providers to care for critically ill COVID-19 patients.
Risks of going forward with surgery
If you end up having surgery, you will have a higher risk of being exposed to the virus that causes COVID-19, compared to self-isolating at home. This is also true any time you leave your house.
Hospitals have strict measures in place to minimize these risks, but many are also treating patients with severe COVID-19. So other treatment locations may be a safer bet.
“These risks are probably slightly lower at ambulatory surgery centers, but there is no way to know for certain,” says Nayak. “It also depends on the geographic region and how prevalent the outbreak is at their particular hospital.”
If you are undergoing surgery and have concerns about being exposed to the coronavirus, Peterson suggests that you ask your doctor questions such as:
- Is this procedure essential now or can it wait until we’re beyond the recommended guidelines?
- Will I be intubated?
- What precautions are you taking to ensure my safety while in your clinic or hospital?
- Do you have the resources and staff available to perform my surgery safely?
If you go to your doctor’s office, follow all safety measures
If your doctor still wants to see you in person, ask the office staff what safety measures are in place. Some offices may ask that you wait in your car in the parking lot, rather than in the waiting room. This reduces interactions between people.
If you have any symptoms of COVID-19 — fever, cough or shortness of breath — let your doctor’s office know before leaving home so they can take precautions.
You should also take steps to protect yourself any time you are away from home, such as washing your hands often, staying at least six feet from others whenever possible, and avoiding touching your eyes, nose, and mouth with unwashed hands.
Coping with pain while you wait
Many people with spine problems also have chronic pain, which can range from mild to severe. If your surgery is postponed, you may have to find other ways to cope with the pain while you wait. Nayak says you can continue with your over-the-counter or prescription pain management. If you have been told to stop after a certain point or need a refill on your prescription, check in with your doctor’s office. There are also non-medical options for pain relief.
“Physician anesthesiologists and other pain specialists can offer a variety of options for pain relief that don’t involve opioids or surgery,” says Peterson, “including radio waves, spinal cord stimulation and nerve blocks.”
Most physical therapy and chiropractor services have also been temporarily suspended during the pandemic. If you have been relying on these to help with your pain, Nayak recommends checking with your physical therapist to see if they offer telemedicine, or using online physical therapy videos at home. However, “if something hurts, don't do it,” he says.
You can even try other therapies such as yoga, meditation, or Mindfulness-Based Stress Reduction (MBSR). While you may not be able to go to your regular physical therapy or massage appointments right now, postponing these and elective surgeries are important for protecting both public health and the health of those most at risk.
“It's everyone's responsibility at this time to follow the government recommendations,” says Nayak. “So unless absolutely necessary, I would advise holding off on adjunct treatments that require travel and significant person-to-person contact.”