Are Telemedicine Visits Alone Adequate for Surgical Planning in Spine Patients?

Man doing virtual doctor's visit

In the early weeks of the COVID-19 pandemic, most health care providers quickly pivoted to telemedicine. Although elective surgeries were put on hold in the beginning of the pandemic, these surgeries eventually resumed. Continuing to move procedures forward was particularly important for the care of patients requiring orthopaedic surgeries, including spine surgery.

To determine the value of conducting presurgical consultations by telemedicine, a team of orthopaedic surgeons from Brigham and Women’s Hospital examined whether virtual visits resulted in the same surgical plan for patients having spine surgery as traditional in-person evaluations did. An analysis recently published in The Spine Journal found that in most cases, surgical plans generated solely from telemedicine visits were accurate and did not ultimately change after an in-person visit.

“The pandemic created a unique ecosystem wherein spine and orthopaedic service lines were forced to rely on telemedicine platforms to provide care for patients, limiting risk from in-person interactions,” said senior author Andrew K. Simpson, MD, MBA, MHS, director of minimally invasive spine surgery in the Department of Orthopaedic Surgery at the Brigham. “My colleagues and I were seeing patients via telemedicine and indicating them for specific surgical procedures without ever seeing them in person or performing a physical examination.”

Comparing Virtual and In-Person Visits

Although physical exams play a role in evaluating potential candidates for spine surgery and determining the best course of action, decisions on the most appropriate approach for each patient are primarily based on imaging, such as MRIs. Telemedicine allows orthopaedic surgeons to discuss the results of these imaging tests with patients and to present surgical options and recommendations. Other vital components of presurgical care, such as discussions about recovery and rehabilitation and setting expectations for physical improvement after surgery, also can be provided via telemedicine.

Dr. Simpson and his team, including orthopaedic surgeon Andrew Schoenfeld, MD, and residents Harry Lightsey, Alexander Crawford and Grace Xiong, decided to look at the effectiveness of telemedicine for patients having spinal surgery in more detail. In the study, they evaluated the records of 33 patients who were indicated for surgery between March and July of 2020 after having specific surgical plans discussed and documented during a telemedicine visit. The patients subsequently underwent in-person evaluation prior to surgery.

Of the 33 patients, 31 (94 percent) had no changes to their surgical plan after having an in-person examination. The two patients who did have their surgical plans modified were undergoing multilevel fusions and had the number of levels that were included increased after in-person evaluation.

“In most cases, doing an in-person visit with the patient did not change surgical plans,” Dr. Simpson said. “This study validates that this approach is effective for patients.”

Expanding Telemedicine to Improve Access

According to Dr. Simpson, this research has important implications that will extend far beyond the end of the pandemic.

For one thing, telemedicine can help to limit health care costs by reducing the requirement for physical spaces and the staffing needs that must be met to see larger numbers of patients in person. For patients, it reduces the costs of traveling to appointments and preserves work time that would otherwise be lost during travel to medical offices.

Additionally, telemedicine can help improve access to high-quality academic medical care, especially for patients who live in rural communities or other areas that are far away from top medical centers. It can also enable patients to meet with experts in different parts of the country and determine where they want their surgery without having to travel to multiple locations. This would allow a patient to prioritize the quality of their care over geographic proximity.

“My vision is a future with more domain-specific spine centers of excellence providing higher-quality and more efficient care to broader geographic markets,” Dr. Simpson concluded. “This will be a win both for patients and for high-quality spine centers.”