Telemedicine has a future in spine surgery but further evidence needed on appropriate use

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Melvin Makhni

Telemedicine is here to stay in spine surgery due to evidence of high patient satisfaction and significant cost savings but questions remain over whether or not an in-person consultation is necessary prior to surgery and which physical exam manoeuvres are appropriate for telemedicine.

This is according to a recent Delphi study which sought to obtain expert consensus on best practices for appropriate telemedicine utilisation in spine surgery—the findings of which were recently published online in the journal Spine by Melvin Makhni (Brigham and Women’s Hospital, Boston, USA) et al.

In February 2021, an expert panel consisting of 27 spine surgeons from various countries was assembled. 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 categorised as having achieved a consensus.

The expert panel reviewed a total of 59 statements. Of these, 32 achieved consensus. The panel reached consensus that video visits could be utilised 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.

In addition, the experts had consensus that video visits could be appropriate for a variety of visit types including early, mid-term, longer-term postoperative follow-up, follow-up for imaging review, and follow-up after an intervention.

Speaking to Spinal News International, Makhni, said: “Our primary goal was to understand how to optimise use of telemedicine in spine care. By bringing together experts in the field of spine surgery from around the world, we were able to develop consensus-driven statements about best practices for clinical care.

“In addition to clinical factors, we know there are significant non-clinical barriers including political, regulatory, logistical, financial, and technological challenges that limit usage of virtual care. However, we hope that our patient-centric framework can serve as a foundation towards which further efforts and policies can be applied. “


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