Feasibility and effectiveness of telehealth in the management of cervicothoracic and lumbar pain during the first six months of the SARS-CoV-2 pandemic: A case series.

Objectives: The primary study objective is to assess the effectiveness and utility of telehealth in managing spine pain. The secondary objective is to evaluate the feasibility of employing various treatments utilizing telehealth. Study design: Retrospective case series of patients with spinal pain managed primarily by telehealth during the first 6 months of the SARS-CoV-2 pandemic in the United States. Setting: A single center community based out-patient clinic and ambulatory surgical facility. Subjects: 101 consecutive adult patients complaining of cervicothoracic or low back pain presenting to a specialized spine clinic. Methods: Telehealth was the preferred method of consultation for 101 consecutive patients presenting with cervicothoracic and/or low-back pain. After conservative care, patients with continued pain and disability were offered procedures. Disability Index (NDI and ODI) and pain Visual Analog Scores (VAS) were used to determine patient outcomes. Results: 101 new out-patient consultations occurred. Telehealth initial consultation occurred in 98% of cases. There was a total of 504 follow up consultations. Follow up was via telehealth in 69%. Significant neurological abnormalities were detected by telehealth in 3% of patients. The lost to follow up rate was 10%. All 63 interventional procedures performed on 42 patients were completed as planned during telehealth visits. Likewise for all 9 surgical procedures. Outcomes were monitored via telehealth. Overall, for patients with cervicothoracic pain, minimal clinically important differences (MCID) for VAS or NDI were reached in 71%. Overall, the MCID for VAS or ODI for low back pain patients was reached in 70%. Conclusion: Telehealth in our series was easily deployable, highly feasible, allowed accurate monitoring of patient care and resulted in accurate triaging for interventions and surgery. Overall patient outcomes compare favorably with that reported for in-person spinal pain care. Telehealth was effective and easily utilizable.