Abstract Introduction: The aim of this study was to assess the safety of our spinal surgery pathways for patients over the age of 70 years during the COVID-19 pandemic, to guide future management. Methods: A retrospective, single-centre, observational cohort study of all patients over 70 years of age undergoing spinal surgery between June 1 to September 30, 2020, was performed. All patients were stratified by the British Orthopaedic Association (BOA) COVID-19 Patient Risk Assessment Tool. Results: A total of 64 operations on 59 patients were performed. The BOA risk assessment placed 67.8% of patients (n=40) in the high or very high-risk category. A total of 60% of patients (n=36) were over 75 years old. All patients had at least one other comorbidity. Following our green, amber, and red pathways, we had no cases of post-operative COVID-19 on an average follow-up of 71 days. Conclusion: Our study illustrates safe pathways for spinal surgery on patients over 70 years old during the first wave of COVID-19. Risk assessment tools should be used with caution, as age over 65 years was immediately medium-risk. This study would be a useful guide in the management of all elderly patients requiring surgery in the face of further COVID-19 variants or a similar pandemic. Introduction Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported in the city of Wuhan in the Hubei province of China in December 2019 [1,2] . It was declared a pandemic by the WHO on March 11, 2020 [3] . Due to increased demand on the healthcare system in the United Kingdom (UK), in a letter to National Health Service (NHS) staff on March 17, 2020, hospitals in England were advised to stop all non-urgent elective care to provide additional capacity to the COVID-19 response [4,5] […]
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