Telemedicine for Spine Care During the Coronavirus Pandemic

The COVID-19 pandemic has rapidly ushered in the use of telemedicine for spine care.

Peer Reviewed

The COVID-19 pandemic has rapidly ushered in the use of telemedicine (also known as telehealth) for spine care at many institutions in the United States. Texas Back Institute is now nearly 2 weeks into full implementation of telemedicine for noncritical spine care.

Telemedicine is a reality for more spine practices due to the COVID-19 pandemic.Telemedicine is a reality for more spine practices due to the COVID-19 pandemic.

“I have no doubt whatsoever that telemedicine is here to stay,” said Isador H. Lieberman, MD, MBA, FRCSC, Orthopaedic and Spinal Surgeon at Texas Back Institute in Plano, TX. “We are witnessing the change in the way we deliver health care accelerated by necessity.”

“Telemedicine, which was in its infancy, will become a more important part of our everyday practice in the future,” said Richard D. Guyer, MD, Co-Director of the Center for Disc Replacement at Texas Back Institute. “For those patients who used to travel to our offices by plane or car for many hours, telemedicine visits will make follow-up visits much easier. In addition, the obvious advantage of telemedicine is that it will allow millions of people more access to spine care.”

As of March 16, 2020, Texas Back Institute postposed all elective procedures and launched its telemedicine system for nonurgent care. Physicians are only providing in-office services for patients with critical spine care issues.

“We wanted to do our part as responsible health care providers to limit the flow of traffic and make sure our patients aren’t vectors of this contagious disease,” Dr. Lieberman said.

Follow-up Care is “Easy” for Most Postsurgical Patients

Using telemedicine for follow-up postoperative care is relatively easy as most patients as are doing well, Dr. Lieberman said. Physicians can conduct functional assessments and check for incision healing via telemedicine. If imaging studies are needed, those are obtained ahead of time and transferred to the institute electronically for physicians to review before the telemedicine appointment. 

Telemedicine also is ideal for monitoring scoliosis progression in children or adults, Dr. Lieberman said. Additionally, 3D motion capture technology is evolving quickly and may be used in the near future to help physicians analyze and measure patients’ gait remotely, he said. 

For new patients, Dr. Lieberman uses telemedicine as an introduction to the patient and to triage out critical cases that require immediate in-person assessment. Even for noncritical cases, he stressed the importance of seeing all new patients face to face at some point for a full neurological examination. Critical cases that should be seen in person, according to Dr. Leiberman, may include: 

  • Progressive neurological deficit
  • Spine tumors
  • Any postop patient not doing well

A “speed bump” for new patients is that they may not have a copy of their previous imaging studies or may only have imaging studies on a CD and have to find a way to transfer those images electronically or drive to drop off the CD at Dr. Lieberman’s office.

The workaround is that many diagnostic imaging centers are allowing practices to download imaging studies directly into their electronic medical record system.

Launching Telemedicine for Spine Care

“We have the privilege of having tech savvy physician partners who researched all of the readily available telemedicine platforms,” Dr. Lieberman said. The physicians at Texas Back Institute then tried out the platforms and helped in the decision-making process, he said.

Use of telemedicine involves a learning curve for both patients and physicians. One of Dr. Lieberman’s first telemedicine consultations involved a patient who initially couldn’t hear Dr. Lieberman. Dr. Lieberman held up a note on a piece of paper asking the patient to make sure the computer speakers were on, which solved the problem.

Now, a medical assistant calls each patient in advance of the appointment to provide education on how to best use telemedicine and Texas Back Institute posts instructions online for patients. Patients are able to use their smartphones, computers, or tablets for the telemedicine appointments. Dr. Lieberman said most patients are used to using Facetime and other videoconferencing services, and are generally savvy when using telemedicine. 

In terms of reimbursement, it is too soon to tell if any issues will arise with private insurance companies. However, Dr. Lieberman does not expect any issues, especially given the Centers for Medicare & Medicaid Services has relaxed its restrictions in response to the COVID-19 crisis, enabling patients access to a wider range of telehealth services.

Benefits of Telemedicine

One of Dr. Lieberman’s initial concerns was how to focus patients during telemedicine appointments, as this can be a challenge during inpatient visits. However, patients almost universally get right to the point with their questions and concerns using telemedicine, he said.

“I have found telemedicine to be very efficient so far,” Dr. Lieberman said. Another benefit is reducing travel time and inconvenience for patients, as Dr. Lieberman treats many patients who live out of state or have to travel an hour or more in-state to reach his office.

“Just think of the environmental and safety benefits,” Dr. Lieberman said. “I think telemedicine is going to be a very convenient method of health care as we move forward across all disciplines.”

Dr. Lieberman concluded that spine care practitioners should be “patient as we go through this evolution. We are all learning.”

Is your facility using telemedicine? What do you like about it? What are your biggest challenges? Tweet us @SpineUniverse and let us know.


Dr. Lieberman is a consultant/independent contractor for Globus Medical, Medtronic, Misonix, and SI-BONE.

Updated on: 03/27/20
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