The Impact of the COVID-19 Pandemic on Spine Surgery Caseloads: A Global Systematic Review

Introduction: The COVID-19 pandemic significantly disrupted healthcare systems globally, particularly elective spine surgeries. This systematic review examines how the pandemic affected spine surgery volumes, patient demographics, presenting complaints, and surgical types by comparing data from 2020 to pre-pandemic years

Methods: A comprehensive search of PubMed, Google Scholar, Cochrane, and Scopus was performed following PRISMA guidelines. Data on patient demographics, presenting complaints, conditions, and surgery volumes in pre-pandemic years and 2020 were analyzed. Statistical analysis was performed to identify significant differences between the two periods.

Results: A total of 52 retrospective studies from 17 countries were included. Low back pain as a presenting complaint decreased significantly from pre-pandemic to 2020 (53.68% vs 33.33%, p = 0.0364). Microdiscectomies also showed a significant decline, from 29.24% of cases pre-pandemic to 18.95% in 2020 (p < 0.001). Overall, elective surgeries decreased from 67.59% pre-pandemic to 45.63% in 2020, though this did not reach the level of statistical significance (p=0.066). In contrast, emergent surgeries remained stable, with a slight decrease from 26.38% pre-pandemic to 22.22% in 2020 (p=0.751). No significant differences were observed in surgery volumes for discectomy, spinal fusion, laminectomy, decompression, or cervical fusion procedures (p>0.05). Furthermore, no significant differences were found for spinal cord injuries, tumors, traumatic conditions, or degenerative disc disease between pre-pandemic years and 2020.

Conclusion : The COVID-19 pandemic led to a reduction in elective spine surgeries, particularly microdiscectomy. However, most services resumed post-peak pandemic, resulting in no significant changes for many surgical conditions. Emergent surgeries, including those for spinal cord injuries and tumors, remained largely stable. These findings highlight the pandemic’s impact on elective spine procedures while ensuring continuity of care for urgent conditions. This impact on elective cases may have resulted in more severe presentations in patients who experienced delayed care during the pandemic.