Pulmonary Inflammation and Injury Triggered by Spine Surgery in Recovered COVID-19 Patients Demand Consideration

Patients with COVID-19, caused by SARS-CoV-2 infection, have presented with fever, cough, dyspnea, pneumonia, acute lung injury, and other respiratory symptoms.[1] An inflammatory overreaction, called a cytokine storm, has also been associated with severe COVID-19.[2] Cytokine storm involves elevated levels of circulating cytokines and hyperactivation of immune system cells.[3] Patients with mild COVID-19 can also produce elevated levels of pro-inflammatory cytokines.[4] Furthermore, those patients present dysregulated expression of genes related to immune functions.[4] Consequently, the immune disorder can hinder a return to homeostasis, leading to multiorgan dysfunction or even multiorgan failure.[3] The pathophysiological consequences of cytokine storm also include circulatory coagulopathy and acute respiratory distress syndrome.[3] In this context, the hyper-inflammatory state and physiological disruption caused by SARSCoV-2 infection hinder the patient’s recovery from physiological stress and injury caused by surgery procedures, for example.