Three Spine Specialists Tell Us What to Expect at Your First Telehealth Appointment

You’ve likely had a telehealth appointment in the past year. Even though life is getting back to normal as COVID-19 subsides, telehealth is here to stay. We spoke with three surgeons about what to expect moving forward.

Telehealth Appointments for Spine Patients

1) Todd J. Albert, MD
Surgeon-in-Chief Emeritus Hospital for Special Surgery

Telehealth has been a great innovation for both patients and doctors relative to accessibility and the ability to experience a relatively normal physician-patient encounter in terms of information gathering and satisfaction for the patient. In preparation for your first telehealth visit, you should provide the doctor with two items. The most important is to provide access to any images you have, such as xrays, MRI, and CT scans of the spine so that they can look at them before seeing you. The second is a brief description of what the problem is. This is very helpful in starting the conversation.

The visit could be as detailed as a visit in the clinic with the doctor gathering the information about your past medical history, your past surgical history, medications, allergies, smoking and alcohol history, and your social history. They will ask you specific details of your current problem and prior treatments for that problem. There should then be a modified examination, which is clearly not as easy as when done in person, but much can be accomplished during the allotted time. For example, a jug of water or orange juice can be used for strength testing.

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Having the ability to walk away from the camera can test your gait and allow the physician to see you while you are performing some simple functions, which is very helpful as well. At the end of the visit the doctor will likely be able to make a presumptive diagnosis and then may decide on an initial treatment with you, discuss the need for further imaging, or perhaps schedule to see you in person.

The telehealth visit should be a pleasant interactive experience with at minimum a first step towards effective diagnosis and treatment. Therefore a telehealth visit is recommended rather than putting off your initial consultation or follow up visit.

Hear more in our interview with Dr. Albert below:

2) Jonathan Rasouli, MD
Associate Staff Neurosurgeon Cleveland Clinic

The rise of telemedicine during the coronavirus pandemic has been a positive change for both physicians and patients. Telemedicine services have enabled patients to receive high-quality spine care while simultaneously protecting against environmental coronavirus exposure. In effect, a patient can speak with a spine surgeon from the safety and comfort of their homes. In addition, it also makes the process of obtaining a second opinion or seeing an out-of-state physician much easier and efficient.

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At your first telehealth visit, you can expect to speak with your spine provider in the same way you would in his or her clinic. Your surgeon will take a detailed history and review your imaging scans, such as an MRI, and develop a treatment plan. The main difference between a telehealth versus an in-person visit, is the lack of a physical
exam. Therefore, it is important to discuss any symptoms other than pain, such as weakness, numbness, or paresthesias with your spine surgeon so he or she is well aware of your condition. A typical telehealth visit will last somewhere between 15-30 minutes and you can expect further follow-up communications once a treatment plan has been developed.

As the technologies that power telehealth programs continue to improve, the user-friendliness of the hosting programs will continue to improve in tandem. In conclusion, telehealth visits are simple, safe, efficient, and are beneficial to both patients and providers, alike. Therefore, your first telehealth visit will likely be a great experience!

Check out our recent interview with Dr. Rasouli:

3) Jeremy Steinberger, MD
Director of Minimally Invasive Spine Surgery Mount Sinai Health System

Televisits with your spine surgeon are a great way to have an initial consultation or a follow up visit without making a trip in. This is especially true in Manhattan, where it can take an hour just to find a parking spot. From the comfort of your own home, you can consult with a spine specialist. Most surgeons have now adapted to the Covid pandemic and are set up to video conference with patients.

I typically start with a general introduction and obtaining a history but asking a series of questions. For example, do you have neck pain, back pain, arm pain, and/or leg pain? Is there any associated numbness or tingling, weakness, urinary or bowel difficulties? How is this impacting your life, mood, activities of daily living, balances, sleep, or ambulation? What makes it better or worse?

Then we move on to the physical examination which is the most challenging part of a televisit. Ultimately, nothing replaces an in- person physical examination which is critical to the surgical decision making process. I have evolved to being more creative on these televisits to try and replicate the in-office appointment. We do this by incorporating rubber bands, heavy books, and other gadgets or tools to provide the best information.

Finally, I am experimenting with virtual reality and augmented reality to make 3-dimensional models of the patient’s anatomy to show them their pathology and what surgical approaches are best for their unique pathology.

All in all, this is a chaotic and unusual time and we are all doing our best to roll with the punches and find creative ways to make the virtual visit as beneficial and convenient as possible, while maintaining a high level of quality.

Read more in our quarterly Spine Health Journal.