Remote Virtual Spinal Evaluation in the Era of COVID-19

Jang W Yoon; Rachel L Welch; Todd Alamin; William F Lavelle; Ivan Cheng; Mick Perez-Cruet; Louis C Fielding; Rick C Sasso; R J Linovitz; Kee D Kim; William C Welch

doi:10.14444/7057

Remote Virtual Spinal Evaluation in the Era of COVID-19

Int J Spine Surg. 2020 Jun 30;14(3):433-440. doi: 10.14444/7057. eCollection 2020 Jun.

Authors

Affiliations

¹ Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
² Yale College, Yale University, New Haven, Connecticut.
³ Department of Orthopedic Surgery and Neurosurgery, Stanford University Medical Center, Redwood City, California.
⁴ Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York.
⁵ Department of Neurological Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
⁶ Empirical Spine Inc., San Carlos, California.
⁷ Indiana Spine Group, Carmel, Indiana.
⁸ PJ Surgical Inc., Rancho Santa Fe, California.
⁹ University of California, Davis School of Medicine, Sacramento, California.

PMID: 32699768
PMCID: PMC7343271
DOI: 10.14444/7057

Abstract

Background: With the COVID-19 pandemic disrupting many facets of our society, physicians and patients have begun using telemedicine as a platform for the delivery of health care. One of the challenges in implementing telemedicine for the spine care provider is completing a comprehensive spinal examination. Currently, there is no standardized methodology to complete a full spinal examination through telemedicine.

Methods: We propose a novel, remote spinal examination methodology that is easily implemented through telemedicine, where the patient is an active participant in the successful completion of his or her examination. This type of examination has been validated in a neurology setting. To facilitate the telemedicine visit, we propose that video instruction be shared with the patient prior to the telemedicine visit to increase the efficacy of the examination.

Results: Since the issuance of stay-at-home order across the states, many spine practices around the country have rapidly adopted and increased their telemedicine program to continue provide care for patients during COVID-19 pandemic. At a tertiary academic center in a busy metropolitan area, nearly 700 telemedicine visits were successfully conducted during a 4-week period. There were no remote visits being done prior to the shutdown.

Conclusions: Implementation of our proposed remote spinal examination has the potential to serve as a guideline for the spine care provider to efficiently assess patients with spine disease using telemedicine. Because these are only suggestions, providers should tailor examination to each individual patient's needs.

Level of evidence: V.

Clinical relevance: It is likely that physicians will incorporate telemedicine into health care delivery services even after the COVID-19 pandemic subsides because of telemedicine's efficiency in meeting patient needs. Using the standard maneuvers provided in our study, spine care providers can perform a nearly comprehensive spine examination through telemedicine. Further studies will be needed to validate the reproducibility and reliability of our methodology.

Keywords: motor examination; neurologic examination; neurosurgery; orthopedics; spine examination; spine surgery; telemedicine; virtual clinic; virtual spine evaluation.