Appropriate Telemedicine Utilization in Spine Surgery: Results From a Delphi Study — The International Society for the Study of the Lumbar Spine
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  3. Appropriate Telemedicine Utilization in Spine Surgery: Results From a Delphi Study

Appropriate Telemedicine Utilization in Spine Surgery: Results From a Delphi Study (#25)

Sravisht Iyer 1 , Patawut Bovonratwet 1 , Dino Samartzis 2 , Andrew J. Schoenfeld 3 , Howard S. An 2 , Waleed Awwad 4 , Scott L. Blumenthal 5 , Jason P.Y. Cheung 6 , Peter B. Derman 5 , Mohammad El-Sharkawi 7 , Brett A. Freedman 8 , Roger Hartl 9 , James D. Kang 3 , Han Jo Kim 1 , Philip K. Louie 10 , Steven C. Ludwig 11 , Marko H. Neva 12 , Martin H. Pham 13 , Frank M. Phillips 2 , Sheeraz A. Qureshi 1 , Kris E. Radcliff 14 , K. Daniel Riew 15 , Harvinder S. Sandhu 1 , Daniel M. Sciubba 16 , Rajiv K. Sethi 17 , Marcelo Valacco 18 , Hasan A. Zaidi 3 , Corinna C. Zygourakis 19 , Melvin C. Makhni 3
  1. Hospital for Special Surgery/Cornell Medical Center Program - New York, NY, New York, NY, United States
  2. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, United States
  3. Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
  4. Department of Orthopaedic Surgery, King Saud University, Riyadh, Saudi Arabia
  5. Department of Orthopaedic Surgery, Texas Back Institute, Dallas, TX, USA
  6. Department of Orthopaedic Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
  7. Department of Orthopaedic Surgery, Assiut University Medical School, Assiut, Egypt
  8. Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
  9. Department of Neurosurgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
  10. Virginia Mason Medical Center, Neuroscience Institute, Seattle, WA, USA
  11. Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
  12. Department of Orthopaedic Surgery, Tampere University Hospital, Tampere, Finland
  13. Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA
  14. Department of Orthopaedic Surgery, Thomas Jefferson University, Rothman Institute, Township, NJ, USA
  15. Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, NY, USA
  16. Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA
  17. Virginia Mason Medical Center and University of Washington, Seattle, WA, USA
  18. Hospital Churruca Visca, Buenos Aires, Argentina
  19. Department of Neurosurgery, Stanford University, Palo Alto, CA, USA

Introduction:
Several studies have shown high patient satisfaction associated with telemedicine during the COVID-19 peak pandemic period as well as after easing of restrictions. As this technology will most likely continue to be employed, there is a need to define appropriate utilization. Therefore, the objective of the current study were to obtain expert consensus on best practices for appropriate telemedicine utilization in spine surgery.

Methods:
An expert panel consisting of 27 spine surgeons from various countries was assembled in February 2021. A two-round consensus-based Delphi method was used to generate consensus statements on various aspects of telemedicine (separated as video visits or audio visits) including themes, such as patient location and impact of patient diagnosis, on assessment of new patients. Topics with ≥75% agreement were categorized as having achieved a consensus.

Results:
The expert panel reviewed a total of 59 statements. Of these, 32 achieved consensus. The panel had consensus that video visits could be utilized regardless of patient location and that video visits are appropriate for evaluating as well as indicating for surgery multiple common spine pathologies, such as lumbar stenosis, lumbar radiculopathy, and cervical radiculopathy. Finally, the panel had consensus that video visits could be appropriate for a variety of visit types including early, mid-term, longer-term post-operative follow-up, follow-up for imaging review, and follow-up after an intervention (i.e. physical therapy, injection).

Conclusions:
This is the first study, to our knowledge, to provide expert consensus on best practices for appropriate telemedicine utilization in spine surgery. To summarize, there was consensus that video-based telemedicine could be utilized regardless of patient location, is sufficient for evaluation and indication of surgery for multiple common spine pathologies, such as lumbar stenosis, lumbar radiculopathy, as well as cervical radiculopathy, and could be appropriate for various visit types. The results of the current study help elaborate optimal conditions and criteria for implementation of telemedicine in the evaluation of patients with spine conditions. 

 

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