Scoring System to Triage Patients for Spine Surgery in the Setting of Limited Resources: Application to the Coronavirus Disease 2019 (COVID-19) Pandemic and Beyond

Daniel M. Sciubba, Jeff Ehresman, Zach Pennington, Daniel Lubelski, James Feghali, Ali Bydon, Dean Chou, Benjamin D. Elder, Aladine A. Elsamadicy, C. Rory Goodwin, Matthew L. Goodwin, James Harrop, Eric O. Klineberg, Ilya Laufer, Sheng Fu L. Lo, Brian J. Neuman, Peter G. Passias, Themistocles Protopsaltis, John H. Shin, Nicholas TheodoreTimothy F. Witham, Edward C. Benzel

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background: As of May 4, 2020, the coronavirus disease 2019 (COVID-19) pandemic has affected >3.5 million people and touched every inhabited continent. Accordingly, it has stressed health systems worldwide, leading to the cancellation of elective surgical cases and discussions regarding health care resource rationing. It is expected that rationing of surgical resources will continue even after the pandemic peak and may recur with future pandemics, creating a need for a means of triaging patients for emergent and elective spine surgery. Methods: Using a modified Delphi technique, a cohort of 16 fellowship-trained spine surgeons from 10 academic medical centers constructed a scoring system for the triage and prioritization of emergent and elective spine surgeries. Three separate rounds of videoconferencing and written correspondence were used to reach a final scoring system. Sixteen test cases were used to optimize the scoring system so that it could categorize cases as requiring emergent, urgent, high-priority elective, or low-priority elective scheduling. Results: The devised scoring system included 8 independent components: neurologic status, underlying spine stability, presentation of a high-risk postoperative complication, patient medical comorbidities, expected hospital course, expected discharge disposition, facility resource limitations, and local disease burden. The resultant calculator was deployed as a freely available Web-based calculator ( Conclusions: We present the first quantitative urgency scoring system for the triage and prioritizing of spine surgery cases in resource-limited settings. We believe that our scoring system, although not all encompassing, has potential value as a guide for triaging spine surgical cases during the COVID pandemic and post-COVID period.

Original languageEnglish (US)
Pages (from-to)e373-e380
JournalWorld neurosurgery
StatePublished - Aug 2020


  • COVID-19
  • Medical ethics
  • Pandemic
  • Rationing
  • Resource allocation
  • Spine surgery
  • Triage

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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