Sravisht Iyer1, Patawut Bovonratwet1, Dino Samartzis2, Andrew J Schoenfeld3, Howard S An2, Waleed Awwad4, Scott L Blumenthal5, Jason P Y Cheung6, Peter B Derman5, Mohammad El-Sharkawi7, Brett A Freedman8, Roger Hartl9, James D Kang3, Han Jo Kim1, Philip K Louie10, Steven C Ludwig11, Marko H Neva12, Martin H Pham13, Frank M Phillips2, Sheeraz A Qureshi1, Kris E Radcliff14, K Daniel Riew15, Harvinder S Sandhu1, Daniel M Sciubba16, Rajiv K Sethi17, Marcelo Valacco18, Hasan A Zaidi19, Corinna C Zygourakis20, Melvin C Makhni3. 1. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. 2. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL. 3. Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 4. Orthopedic Surgery Department, King Saud University, Riyadh, Saudi Arabia. 5. Department of Orthopedic Surgery, Texas Back Institute, Dallas, TX. 6. Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China. 7. Department of Orthopaedic and Trauma Surgery, Assiut University Medical School, Assiut, Egypt. 8. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN. 9. Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY. 10. Virginia Mason Medical Center, Neuroscience Institute, Seattle, WA. 11. Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD. 12. Department of Orthopaedics and Trauma, Tampere University Hospital, Tampere, Finland. 13. Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA. 14. Department of Orthopedic Surgery, Thomas Jefferson University, Rothman Institute, 2500 English Creek Avenue, Egg Harbor Township, NJ 08234. 15. Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, NY. 16. Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY 11030. 17. Virginia Mason Medical Center and University of Washington, 125 16th Avenue East, CSB-3 Neurosurgery Seattle, WA, 98112. 18. Department of Orthopedic and Traumatology, Hospital Churruca Visca, Buenos Aires, Argentina. 19. Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 20. Department of Neurological Surgery, Stanford University, 300 Pasteur Drive, Palo Alto, CA 94304.
Abstract
STUDY DESIGN: Delphi expert panel consensus. OBJECTIVE: To obtain expert consensus on best practices for appropriate telemedicine utilization in spine surgery. SUMMARY OF BACKGROUND DATA: 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. 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, midterm, longer term postoperative follow-up, follow-up for imaging review, and follow-up after an intervention (i.e., physical therapy, injection). CONCLUSION: Although telemedicine was initially introduced out of necessity, this technology most likely will remain due to evidence of high patient satisfaction and significant cost savings. This study was able to provide a framework for appropriate telemedicine utilization in spine surgery from a panel of experts. However, several questions remain for future research, such as whether or not an in-person consultation is necessary prior to surgery and which physical exam maneuvers are appropriate for telemedicine.Level of Evidence: 4.
STUDY DESIGN: Delphi expert panel consensus. OBJECTIVE: To obtain expert consensus on best practices for appropriate telemedicine utilization in spine surgery. SUMMARY OF BACKGROUND DATA: 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. 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, midterm, longer term postoperative follow-up, follow-up for imaging review, and follow-up after an intervention (i.e., physical therapy, injection). CONCLUSION: Although telemedicine was initially introduced out of necessity, this technology most likely will remain due to evidence of high patient satisfaction and significant cost savings. This study was able to provide a framework for appropriate telemedicine utilization in spine surgery from a panel of experts. However, several questions remain for future research, such as whether or not an in-person consultation is necessary prior to surgery and which physical exam maneuvers are appropriate for telemedicine.Level of Evidence: 4.
Authors: Juan N Barajas; Alexander L Hornung; Timothy Kuzel; Gary M Mallow; Grant J Park; Samuel S Rudisill; Philip K Louie; Garrett K Harada; Michael H McCarthy; Niccole Germscheid; Jason Py Cheung; Marko H Neva; Mohammad El-Sharkawi; Marcelo Valacco; Daniel M Sciubba; Norman B Chutkan; Howard S An; Dino Samartzis Journal: Global Spine J Date: 2022-09-29