Telemedicine Visits Can Generate Highly Accurate Diagnoses and Surgical Plans for Spine Patients

Abstract

Study Design. A Retrospective cohort study. Objective. To (1) assess whether diagnoses and surgical plans established during a new patient telemedicine visit changed following an in-person evaluation and (2) determine any differences in perioperative outcomes between patients who only had a telemedicine visit before surgery versus those who had a telemedicine visit followed by an in-person evaluation before surgery. Summary of Background Data. Data on capability of telemedicine to deliver high-quality preoperative assessment without a traditional in-person interaction and physical examination is lacking. Materials and Methods. Records of patients who had a new patient telemedicine visit and indicated for surgery with documented specific diagnosis as well as surgical plans from a spine department at an urban tertiary center from April 2020 to April 2021 were reviewed. For a subset of patients that had a follow-up in-person evaluation before surgery, these diagnoses and plans were compared. Perioperative outcomes were compared between patients who only had a telemedicine visit before surgery versus those who had a telemedicine visit followed by an in-person evaluation before surgery. Results. A total of 166 patients were included. Of these, 101 patients (61%) only had a new patient telemedicine visit before surgery while 65 (39%) had a telemedicine visit followed by an inperson evaluation. There were no differences in the rate of case cancellations before surgery and patient-reported outcome measures between these two groups (P > 0.05). Of 65 patients who had both a telemedicine followed by an in-person visit, the diagnosis was unchanged for 61 patients (94%) and the surgical plan did not change for 52 patients (80%). The main reason for surgical plan change was due to updated findings on new imaging, 10 patients, (77%). Conclusions. The current study suggests that telemedicine evaluations can provide an effective means of preoperative assessment for spine patients.

Telehealth in PM&R: Past, present, and future in clinical practice and opportunities for translational research

“…Telehealth may be particularly effective for the management of patients with spine disorders who have both advanced imaging and appropriate patient history available, including determining interventional procedures and spine surgery 89 . This is supported by a consistency of recommendations and minimal differences between telehealth and an in‐person visit used to determine a procedural or surgical plan 90‐95 . Use of telehealth has been shown to result in high physician confidence to develop treatment plans, 96,97 high patient satisfaction 98‐100 particularly for follow‐up visits 101 and management of low back pain, 102 including exercise programs 103 …”

“…89 This is supported by a consistency of recommendations and minimal differences between telehealth and an in-person visit used to determine a procedural or surgical plan. [90][91][92][93][94][95] Use of telehealth has been shown to result in high physician confidence to develop treatment plans, 96,97 high patient satisfaction [98][99][100] particularly for follow-up visits 101 and management of low back pain, 102 including exercise programs. 103 Although studies are currently limited on telehealth use for evaluating how a patient reports treatment response following the use of procedures to alleviate pain, applications of telehealth visits compared to inperson visits have been evaluated in the management of chronic pain conditions of Achilles tendinopathy and plantar fasciitis.…”

Lumbar fusion during the COVID-19 pandemic: greater rates of morbidity and longer procedures

“…However, due to the time-sensitive nature of certain spinal pathologies, the spine service has remained relatively more active than other orthopaedic specialties, even during the initial peak of the pandemic and its associated restrictions ( 3 ). Spine surgeons have a critical role in the pandemic to identify and still treat patients with urgent and emergent spinal conditions while attempting to minimize resource utilization as feasible ( 4 ). Despite the widespread surgery cancellations, care was largely continued for patients presenting with progressive neurological deficits, myelopathy with spinal cord at risk, spine trauma with instability, or cauda equina syndrome ( 5 ).…”

Telehealth for a better service delivery in orthopaedic surgery

“…Nevertheless, there is mounting evidence showing that video-based diagnostic evaluation and decision-making have now reached an acceptable level of accuracy, making them suitable for adoption in orthopaedic surgery. 7,11,26-28…”

“…Nevertheless, there is mounting evidence showing that video-based diagnostic evaluation and decisionmaking have now reached an acceptable level of accuracy, making them suitable for adoption in orthopaedic surgery. 7,11,[26][27][28] Looking beyond the field of surgery, Hersh et al, 29 in their systematic review, found telemedicine to be effective in specialities where verbal interactions form a key component of patient assessment, such as psychiatry and neurology. This suggests it has equal suitability for the management of chronic orthopaedic conditions, where such dialogue is equally pivotal.…”