Introduction: After more than a year since its onset, the COVID-19 pandemic continues to be a significant medical, financial, and social crisis. Varying associated government regulations and public health initiatives have produced unique effects on both medicine and those who practice it across the globe. In April 2020, Louie et al¹ conducted a study assessing the multidimensional impact of COVID-19 on healthcare professionals, particularly spine surgeons, and to identify geographical variations. The current follow-up study serves to evaluate how practices and perceptions of spine surgeons have changed over the past year.

Methods: A multidimensional survey, similar to that reported by Louie et al¹, was distributed via email to 3,805 spine surgeons who were members of AO Spine and agreed to receive surveys. Recipients were given 12 days to complete the 90-item questionnaire (3/26/2021 to 4/6/2021), which was categorized into the following domains: demographics, COVID-19 observations, preparedness, vaccination, personal impact, patient care, and future perceptions. Results were compared with those of the prior survey.¹ Statistical analyses were performed with JASP version 0.15. P values <0.05 were deemed statistically significant.

Results: 275 spine surgeons representing 7 global regions completed the follow-up survey, equating to a response rate of 7.2%. Compared to 6.7% in the original survey, 71.3% of respondents had undergone testing for COVID-19, of which 16.7% tested positive, similar to the 15.8% reported by Louie et al.¹ Eighty-nine (32.4%) reported quarantining at some point during the past year. 64.0% had received at least one dose of the COVID-19 vaccine, with specific vaccine type (e.g., Pfizer, Moderna, etc.) being regionally dependent. Amongst those not yet vaccinated, 53.0% indicated they would immediately get the vaccine once available in their respective countries, whereas 5.1% expressed they do not want the vaccine. Family health concerns continued to be the greatest stressor globally (69.5%). Interestingly, only 37.8% noted expected time to baseline clinical practice as a moderately high stressor, down from 44.9% last year. Sixty-four respondents (23.7%) indicated they anticipate returning to baseline clinical practices within 6-12 months, longer than the most common response last year of 8 weeks (26%). Respondents noted reduced clinical time (46.2%), reduced research activities (29.8%), and poorer training experiences for residents (52.0%) due to the pandemic. Research output and teaching/training was similarly impacted worldwide and in comparison, to last year. Loss of income continued to be the most common response for concern secondary to COVID-19 (28%), which was regionally dependent as well. Finally, 64.0% expressed need for formal, international guidelines to manage COVID-19 patients, a 28% decrease from our prior survey.

Discussion: Spine surgeons around the world continue to experience professional, psychological, and social consequences of COVID-19. Substantial variation in experiences across the globe reflect differences in government regulations, public health initiatives, and overall resource allocation. By highlighting the challenges and needs of spine surgeons around the world, results of this study may serve as a foundation to the development and implementation of guidelines that promote a return to safe and effective healthcare provision amid a global health crisis.