Spine Surgery During COVID-19: A Case Study

When S.M. experienced a large growth spurt between age 11 and 12, his pediatrician noted the youth’s increased height, that the boy’s shoulders were slightly uneven and his spine noticeably curved. The physician referred S.M.’s family to the Division of Orthopaedics at Children’s Hospital of Philadelphia (CHOP) for evaluation.

S.M. came to CHOP’s Specialty Care Center in Chalfont, Pa., near the family’s home. After an evaluation, we diagnosed him with adolescent idiopathic scoliosis. At the time, S.M.’s spinal curve was 40 degrees. If it continued to curve, we knew it may eventually cause heart or lung problems.

Path to posterior spinal fusion

We recommended S.M. wear a back brace in the hopes of halting or slowing the progression of the curve. As an active adolescent on two sports teams, it was challenging for S.M. to wear the brace for 18 hours a day — but he did it. However, at a follow-up visit less than 12 months later, S.M.’s spine curve had worsened to 57 degrees after another growth spurt.

At this time, we recommended S.M. undergo posterior spinal fusion surgery. The invasive procedure involves attaching rods to the spine to pull it straight and would correct SM’s scoliosis in a way bracing could not.

Surgery was planned for Spring 2020, when the COVID-19 pandemic struck. Pennsylvania’s governor imposed a stay-at-home order for the state, and CHOP cancelled all non-emergency appointments and elective procedures in an effort to flatten the transmission curve and conserve personal protective equipment for frontline healthcare workers.

Clinicians used that down time to advance research efforts and refine care pathways, including a system for categorizing patients according to risks of delaying care. Learn more about pediatric spine surgery prioritization in the COVID-19 era, published in the Journal of Bone and Joint Surgery.

When the state’s restrictions around COVID were loosened and CHOP resumed elective procedures in early May 2020, S.M. was one of the early spine patients to undergo surgery. S.M.’s family was concerned about him undergoing a major surgical procedure during the pandemic, but their worries were quickly eased when the family arrived at CHOP for the surgery and saw the safety precautions in place.

Rapid recovery pathway

S.M.’s recovery after surgery was swift and steady, following our Rapid Recovery Clinical Pathway for Children with Adolescent Idiopathic Scoliosis Spinal Fusion. The pathway combines a pain management approach with rehabilitation to reduce the rate of surgical complications, ease recovery, and get patients home faster with their pain under control. Before implementation of the pathway, scoliosis surgery patients typically went home five to six days after surgery. Today, the length of stay is usually three to four days at most.

S.M. spent two days in the hospital after surgery and was able to get back to swimming less than two months later. Now 14, S.M. has been entirely pain-free since recovering from the surgery and is back to full function.

Jason B. Anari, MD, is a pediatric orthopaedic surgeon, specializing in the treatment of spine disorders in children, with the Division of Orthopaedics at Children’s Hospital of Philadelphia.