Management of Spine Trauma in COVID-19 Pandemic: A Preliminary Report

Document Type : RESEARCH PAPER


1 Department of Orthopedic Surgery, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran

3 Department of Radiology, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

5 Functional Neurosurgery Research Center, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran


Introduction: COVID-19 was first identified in Iran in February 2020 and since then it spread rapidly through all over the country and soon after reported as a pandemic. The current study present a preliminary report of spine trauma management during COVID-19 pandemic.
Method and Material: A cross sectional study was designed to evaluate patients admitted for vertebral fractures with diagnosis of COVID-19 infection on February, and March 2020. Analysis was made based on clinical and laboratory data in addition to imaging findings from chest HRCT.
Results: Seven patient with spine trauma including 5 males and 2 females ranged from 14 to 59 years were diagnosed for COVID-19 infection through CT-scan findings. Except one, all other patients were asymptomatic for COVID-19 at the time of admission. In three cases the COVID diagnosis was made the day after arrival and in others after 10, 14 and 35 days. Five Patients treated surgically in which 4 admitted to ICU soon after. The mean ICU stay for operated patients were 8 days and mean hospital stay was 22.6 days.
Conclusion: Proper diagnosis of COVID-19 is the keystone to protect both patients and health care providers. During the pandemic all admitted patients should be screened for COVID-19 infection. Unnecessary procedures for spine trauma patients should be avoided in order to reduce complications related to surgery and preserve ICU beds.


1. Zhou P, Yang X-L, Wang X-G, Hu B, Zhang L, Zhang
W, et al. A pneumonia outbreak associated with a
new coronavirus of probable bat origin. Nature.
2. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A
novel coronavirus from patients with pneumonia in
China, 2019. New England Journal of Medicine. 2020.
3. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al.
Clinical Characteristics of 138 Hospitalized Patients
With 2019 Novel Coronavirus-Infected Pneumonia
in Wuhan, China. Jama. 2020 Feb 7. PubMed PMID:
32031570. Pubmed Central PMCID: PMC7042881.
Epub 2020/02/08. eng.
4. Arab-Mazar Z, Sah R, Rabaan AA, Dhama K, Rodriguez-
Morales AJ. Mapping the incidence of the COVID-19
hotspot in Iran–Implications for Travellers. Travel
Medicine and Infectious Disease. 2020.
5. Cucinotta D, Vanelli M. WHO Declares COVID-19
a Pandemic. Acta bio-medica: Atenei Parmensis.
6. Mahdavi A, Khalili N, Davarpanah AH, Faghihi T,
Mahdavi A, Haseli S, et al. Radiologic management
of COVID-19: preliminary experience of the Iranian
Society of Radiology COVID-19 Consultant Group 
(ISRCC). Iranian Journal of Radiology. 2020 (In Press).
7. Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al.
Sensitivity of chest CT for COVID-19: comparison to
RT-PCR. Radiology. 2020:200432.
8. Wilder-Smith A, Freedman D. Isolation, quarantine,
social distancing and community containment: pivotal
role for old-style public health measures in the novel
coronavirus (2019-nCoV) outbreak. Journal of travel
medicine. 2020;27(2):taaa020.
9. Azami-Aghdash S, Sadeghi-Bazargani H, Shabaninejad
H, Gorji HA. Injury epidemiology in Iran: a systematic
review. Journal of injury and violence research.
10. Xu R, Du M, Li L, Zhen Z, Wang H, Hu X. CT imaging
of one extended family cluster of corona virus disease
2019 (COVID-19) including adolescent patients and
“silent infection”. Quantitative Imaging in Medicine
and Surgery. 2020;10(3):800.
11. Cao Y, Liu X, Xiong L, Cai K. Imaging and Clinical
Features of Patients With 2019 Novel Coronavirus
SARS‐CoV‐2: A systematic review and meta‐analysis.
Journal of Medical Virology. 2020.
12. Lei S, Jiang F, Su W, Chen C, Chen J, Mei W, et al. Clinical
characteristics and outcomes of patients undergoing
surgeries during the incubation period of COVID-19
infection. EClinicalMedicine. 2020:100331.
13. Ahuja CS, Schroeder GD, Vaccaro AR, Fehlings MG.
Spinal Cord Injury-What Are the Controversies?
Journal of orthopaedic trauma. 2017 Sep;31
Suppl 4:S7-s13. PubMed PMID: 28816870. Epub
2017/08/18. eng.
14. Liu Z, Yang Y, He L, Pang M, Luo C, Liu B, et al. Highdose
methylprednisolone for acute traumatic spinal
cord injury: A meta-analysis. Neurology. 2019 Aug
27;93(9):e841-e50. PubMed PMID: 31358617. Epub
2019/07/31. eng.
15. Rabinstein AA. Traumatic Spinal Cord Injury.
Continuum (Minneapolis, Minn). 2018 Apr;24(2,
Spinal Cord Disorders):551-66. PubMed PMID:
29613899. Epub 2018/04/04. eng.
16. Rouanet C, Reges D, Rocha E, Gagliardi V, Silva GS.
Traumatic spinal cord injury: current concepts and
treatment update. Arquivos de neuro-psiquiatria.
2017 Jun;75(6):387-93. PubMed PMID: 28658409.
Epub 2017/06/29. eng.
17. Russell CD, Millar JE, Baillie JK. Clinical evidence does
not support corticosteroid treatment for 2019-nCoV
lung injury. The Lancet. 2020;395(10223):473-5.
18. Bohl DD, Mayo BC, Massel DH, Iantorno SE, Ahn
J, Basques BA, et al. Incidence and risk factors for
pneumonia after posterior lumbar fusion procedures:
an ACS-NSQIP study. Spine. 2016;41(12):1058-63.
19. Mobley SR, Miller BT, Astor FC, Fine B, Halliday NJ.
Prone positioning for head and neck reconstructive
surgery. Head & Neck: Journal for the Sciences and
Specialties of the Head and Neck. 2007;29(11):1041-5.
20. Schonauer C, Bocchetti A, Moraci A, Barbagallo G,
Albanese V. Positioning on surgical table. Haemostasis
in Spine Surgery: Springer; 2005. p. 50-5.
21. Hebert JS, Burnham RS. The effect of polytrauma in
persons with traumatic spine injury: a prospective
database of spine fractures. Spine. 2000;25(1):55.