As a respiratory pathogen, the novel coronavirus is commonly associated with aerosol-generating procedures. However, it is currently unclear whether spinal surgical procedures pose an additional risk of viral transmission to the surgical team. We reviewed the available evidence to ascertain the presence of coronavirus disease 2019 (COVID-19) blood viremia and the virus’ blood transmissibility, as well as evidence of blood-aerosol generation and operating room contamination from spinal surgical procedures. There is established evidence of COVID-19 blood viremia, a viral pathogenic cycle via angiotensin-converting enzyme 2 (ACE-2) receptors and similar blood transmission risk data from the SARS (severe acute respiratory syndrome)/MERS (Middle East respiratory syndrome) era. Spinal surgical practices demonstrate significant blood-aerosol generation from the operative wound due to the use of common surgical instruments, such as electrocautery, as well as high-speed and high-impact devices. Based on the evidence, there is an established additional risk of viral transmission faced by surgical teams from blood-aerosols generated from the operative wound of COVID-19- infected patients via the inhalation of virus-laden aerosols and the subsequent initiation of the viral pathogenic cycle through binding with pulmonary ACE-2 receptors. Recognizing this additional risk amidst the ongoing pandemic serves as a caution to front-line surgical personnel to strictly adhere to personal protective equipment usage in operating rooms, to modify surgical techniques to reduce the hazard of surgical aerosol generation and COVID-19 viral exposure, and to consider it as an integral aspect of planning and adapting to the “new normal” operating practices.

Methods: A prospective, single-center, consecutive cohort study was conducted over a period of 30 months. All new patients with low back-related disorders regardless of pathology completed a Yellow Flag Questionnaire that was adapted from the psychosocial flags framework. Clinicians assessing these patients completed a standardized form to determine which and how many yellow flags they had identified during the consultation. Results: A total of 130 patients were included in the analysis, and the clinicians reported an average of 5 flags (range, 0–9). Fear of movement or injury was the most frequently reported yellow flag, reported by 87.7% (n=114) of patients. Clinician sensitivity in detecting yellow flags was poor, correctly identifying only 2 flags, on average, of the 5 reported by patients, with an overall sensitivity of only 39%. Conclusions The ability of spine specialists to identify yellow flags is poor and can be improved by asking patients to complete a simple screening questionnaire.

Methods: A prospective, single-center, consecutive cohort study was conducted over a period of 30 months. All new patients with low back-related disorders regardless of pathology completed a Yellow Flag Questionnaire that was adapted from the psychosocial flags framework. Clinicians assessing these patients completed a standardized form to determine which and how many yellow flags they had identified during the consultation. Results: A total of 130 patients were included in the analysis, and the clinicians reported an average of 5 flags (range, 0–9). Fear of movement or injury was the most frequently reported yellow flag, reported by 87.7% (n=114) of patients. Clinician sensitivity in detecting yellow flags was poor, correctly identifying only 2 flags, on average, of the 5 reported by patients, with an overall sensitivity of only 39%. Conclusions The ability of spine specialists to identify yellow flags is poor and can be improved by asking patients to complete a simple screening questionnaire.