Background During the COVID-19 pandemic, the spine surgeon had to deal with some new challenges in treating emergency spine cases. This paper aimed to report our experience with spine emergency surgery during the pandemic, with already limited resources for surgery. Methods This was a retrospective, single-center study, involving all patients admitted to our hospital during a period of 1st March – 31 st December 2020 and underwent emergent spinal surgery. The data were collected from the patients’ medical records. Results We found 15 patients who met the inclusion criteria. Four patients were suspected to be infected by COVID-19, but none of them was confirmed to be infected by COVID-19 based on the PCR test. All patients had a history of injury: fell from height (53.3%), traffic accident (40%), and direct trauma (6.7%). The average time interval from injury to hospital admission was 38.6 h, from admission to surgery was 6.3 days, and from injury to surgery was 8.1 days. The patient who was suspected to be infected with COVID-19 has a significantly greater time interval from admission to surgery (p = 0.012). The surgery lasted for 3–6 h, with an average of 4.6 h. The average hospital stay duration was 13.3 days and it has a significant positive correlation with the time interval from admission to surgery (p = 0.001). Three months post-operatively, seven patients experienced an improvement in the Frankel grade, 4 patients had no changes in Frankel grade, and 2 patients died. Conclusion To our experience, the lack of human and material resources during the pandemic caused some delay in surgery. However, surgery performed later than 24 h during the pandemic might still bring benefit to the patient.

Highlights Challenges in transforaminal endoscopic lumbar discectomy for L5 – S1 disc herniation Experience of transforaminal endoscopic lumbar discectomy for L5 – S1 disc herniation Outcome of transforaminal endoscopic lumbar discectomy for L5 – S1 disc herniation

BACKGROUND: The changes of lifestyle and mobility during the coronavirus disease 2019 (COVID-19) pandemic may influence the epidemiology of traumatic fractures. AIM: This study aimed to investigate the epidemiology of traumatic fractures in Yogyakarta Special Region (Daerah Istimewa Yogyakarta [DIY]) during the COVID-19 emergency response period and compare the data with the similar period in the previous year. METHODS: This was a retrospective study involving five secondary referral hospitals and one tertiary referral hospital. We included all patients who presented to the emergency departments or orthopedic clinics who were then diagnosed with new-onset fractures. We compared the data during the emergency response period (COVID group) with a similar period in 2019 (control group). RESULTS: There were 1249 patients with 1428 fractures included in this study. There was 47.68% reduction of patients during the emergency response period. There was no significant difference in proportion of gender and mean of age (control group vs. COVID group: 55.9% vs. 54.8%, p = 0.717 for male gender; 42.64 ± 24.03 years vs. 42.20 ± 23.34 years, p = 0.886 for mean of patients’ age). There were significant increases in the proportions of patients experiencing low-energy injuries (38.0% vs. 30.8%, p = 0.012), injuries occurring at home (34.0% vs. 23.8%, p = 0.001), and surgically treated closed fractures (51.8% vs. 45.3%, p = 0.038), along with decrease of patients’ referrals (1.6% vs. 4.1%, p = 0.018) during the pandemic. The difference in proportions of fracture type, osteoporotic fractures, and multiple trauma was not significant (control group vs. COVID group: 19.2% vs. 17.4%, p = 0.418 for open fracture; 15.4% vs. 14.7%, p = 0.750 for osteoporotic fracture; and 9.0% vs. 7.0%; p = 0.217 for multiple trauma). CONCLUSIONS: During the COVID-19 emergency response period in DIY, there were nearly half reduction of patients with fractures, increased proportion of patients injured at home, reduced proportion of patients referred to another hospital, and increased proportion of surgically treated closed fractures. The knowledge about this epidemiological trend may help in developing preventive programs and treatment policy for fractures and other injuries during the current pandemic.

Background: The changes of lifestyle and mobility during the Coronavirus Disease 2019 (COVID-19) pandemic may influence the epidemiology of traumatic fractures. This study aimed to investigate the epidemiology of traumatic fractures in Yogyakarta Special Region (Daerah Istimewa Yogyakarta/DIY) during the COVID-19 emergency response period and compare the data with the similar period in the previous year.Methods: This was a retrospective study involving five secondary referral hospitals and one tertiary referral hospital. We included all patients who presented to the emergency departments or orthopedic clinics who were then diagnosed with new onset fractures. We compared the data during the emergency response period (COVID group) with a similar period in 2019 (control group).Results: There were 1,249 patients with 1,428 fractures included in this study. There was almost half reduction of patients during the emergency response period. There was no significant difference in proportion of gender and mean of age between patients in the control group and the COVID group. During the emergency response period, there was significant increases in the proportions of patients experiencing low energy injuries (38.0% vs. 30.8%), injuries occurring at home (34.0% vs. 23.8%), and surgically treated closed fractures (51.8% vs. 45.3%), along with decrease of patients’ referrals (1.6% vs. 4.1%). The difference in proportions of fracture type, osteoporotic fractures, and multiple trauma was not significant across the groups. Conclusions: During the COVID-19 emergency response period in DIY, there were nearly half reduction (47.68%) of patients with fractures, increased proportion of patients injured at home, reduced proportion of patients referred to another hospital, and increased proportion of surgically treated closed fractures. The knowledge about this epidemiological trend may help in developing preventive programs and treatment policy for fractures and other injuries during the current pandemic.