HEALTH SERVICES RESEARCH

Appropriate Telemedicine Utilization in Spine Surgery

Results From a Delphi Study

Iyer, Sravisht MD^a; Bovonratwet, Patawut MD^a; Samartzis, Dino DSc^b; Schoenfeld, Andrew J. MD, MSc^c; An, Howard S. MD^b; Awwad, Waleed MD^d; Blumenthal, Scott L. MD^e; Cheung, Jason P.Y. MBBS^f; Derman, Peter B. MD, MBA^e; El-Sharkawi, Mohammad MD^g; Freedman, Brett A. MD^h; Hartl, Roger MDⁱ; Kang, James D. MD^c; Kim, Han Jo MD^a; Louie, Philip K. MD^j; Ludwig, Steven C. MD^k; Neva, Marko H. MD, PhD^l; Pham, Martin H. MD^m; Phillips, Frank M. MD^b; Qureshi, Sheeraz A. MD, MBA^a; Radcliff, Kris E. MDⁿ; Riew, K. Daniel MD^o; Sandhu, Harvinder S. MD^a; Sciubba, Daniel M. MD^p; Sethi, Rajiv K. MD^q; Valacco, Marcelo MD^r; Zaidi, Hasan A. MD^s; Zygourakis, Corinna C. MD^t; Makhni, Melvin C. MD, MBA^c

Author Information

^aDepartment of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021

^bDepartment of Orthopedic Surgery, Rush University Medical Center, Chicago, IL

^cDepartment of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

^dOrthopedic Surgery Department, King Saud University, Riyadh, Saudi Arabia

^eDepartment of Orthopedic Surgery, Texas Back Institute, Dallas, TX

^fDepartment of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China

^gDepartment of Orthopaedic and Trauma Surgery, Assiut University Medical School, Assiut, Egypt

^hDepartment of Orthopedic Surgery, Mayo Clinic, Rochester, MN

ⁱDepartment of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY

^jVirginia Mason Medical Center, Neuroscience Institute, Seattle, WA

^kDepartment of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD

^lDepartment of Orthopaedics and Trauma, Tampere University Hospital, Tampere, Finland

^mDepartment of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA

ⁿDepartment of Orthopedic Surgery, Thomas Jefferson University, Rothman Institute, 2500 English Creek Avenue, Egg Harbor Township, NJ 08234

^oDepartment of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, NY

^pDepartment of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY 11030

^qVirginia Mason Medical Center and University of Washington, 125 16th Avenue East, CSB-3 Neurosurgery Seattle, WA, 98112

^rDepartment of Orthopedic and Traumatology, Hospital Churruca Visca, Buenos Aires, Argentina

^sDepartment of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

^tDepartment of Neurological Surgery, Stanford University, 300 Pasteur Drive, Palo Alto, CA 94304.

Address correspondence and reprint requests to Melvin C. Makhni, MD, MBA, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School 75 Francis Street Boston 02115, MA; E-mail: [email protected]

Received 9 November, 2021

Revised 7 December, 2021

Accepted 24 December, 2021

The manuscript submitted does not contain information about medical device(s)/drug(s).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.spinejournal.com).

SPINE 47(8):p 583-590, April 15, 2022. | DOI: 10.1097/BRS.0000000000004339

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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

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Appropriate Telemedicine Utilization in Spine Surgery