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Neurosurgery in the Coronavirus lockdown. Italian experience.

SOURCE

Daniel Cabezas, MD, IFAANS

Daniel Cabezas, MD, IFAANS
Senior Executive Consultant in Neurosurgery and Spine Surgery Aurelia & European Hospital(s), Rome – Italy.
2 articles 

I’m reporting and sharing my personal experience as consultant neurosurgeon in Rome (Italy) and the experiences of friends, fellows and colleagues working in my hospital or in others located in Italy.

Following the recently started complete closure of all not strategical activities promulgated in Italy, now I’m starting postulating what the future scenarios will be for my neurosurgical elective practice.

As an initial consideration during the last month the events of acute myocardial infarctions or brain strokes are diminished in frequency, reducing the access to the Emergency facilities. Also sudden and acute clinical pathologies such an appendicitis have become a rare event. This appreciation has been declared from many Italian physicians, colleagues and friends.

The same reduction in terms of acute occurrence are observed for traumatic nor hemorrhagic neurosurgical events, which are consistently diminished probably thanks to the isolation, mobility reduction and segregation into houses.

In north of Italy the elective pathology regarding neurosurgery is today relegated to some neurosurgical centers not devolved to be transformed in “Covid Hospitals” where the worst is today still going on with the Coronavirus influenza.

The future implications on the rest of Italy are still to come whilst the virus spreading’s been hopefully stopped if the new restrictions will work.

The spine surgery activity, which is today the majority of my personal surgical practice is, now, stopped. Surgical treatments are only for emergencies or urgent cases where neurological deficits or traumatic acute events require the immediate intervention. Visits and clinical activities are actually scheduled to the next future starting from April 3rd (the day of the programmed end of the quarantine).

The back office work has indeed a lot increased to maintain the calm and continue the follow up of patients at home, fortunately the total number of new accesses or phone calls due to the ongoing emergency are reduced to nearly 10% of total.

In conclusion it seems to be a sort of complete lockdown, also for not life threatening diseases regarding neurosurgery.

As a final consideration I would like to underline a personal observation.

Spinal degenerative pathologies are worldwide spread but, in the less fortunate countries, the percentage of patients that have access to neurosurgical or spine surgical centers are only a few of all though.

Following that consideration and the actual low number of patients asking for consultations could we postulate that the high availability, in terms of offering of spine surgical centers or neurosurgeries in the more developed countries, is leading the rate number of spinal procedures perfomed?

I understand that this is a very tricky forced consideration considering the particularity of the pandemia, and it is not very long lasting consideration due to the known end of the lockdown. At the end of it patients will be, in fact, able to reach facilities for the visits or the postponed procedures priorly scheduled. Nevertheless I assume could be a good point to follow and try check the treatment in terms of necessity (“what could I do if it weren’t possibile to do it today and in the same way ?”) and regain the role of the conservative treatments available to the spine surgeon.

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