Study Design: Original research, cross-sectional study. Objectives: Evaluate patient satisfaction with spine care delivered via telemedicine. Identify patient- and visit-based factors associated with increased satisfaction and visit preference. Methods: Telemedicine visits with a spine surgeon at 2 practices in the United States between March and May 2020 were eligible for inclusion in the study. Patients were sent an electronic survey recording overall satisfaction, technical or clinical issues encountered, and preference for a telemedicine versus an in-person visit. Factors associated with poor satisfaction and preference of telemedicine over an in-person visit were identified using multivariate logistic regression. Results: A total of 772 responses were collected. Overall, 87.7% of patients were satisfied with their telemedicine visit and 45% indicated a preference for a telemedicine visit over an in-person visit if given the option. Patients with technical or clinical issues were significantly less likely to achieve 5 out of 5 satisfaction scores and were significantly more likely to prefer an in-person visit. Patients who live less than 5 miles from their surgeon’s office and patients older than 60 years were also significantly more likely to prefer in-person visits. Conclusions: Spine telemedicine visits during the COVID-19 pandemic were associated with high patient satisfaction. Additionally, 45% of respondents indicated a preference for telemedicine versus an in-patient visit in the future. In light of these findings, telemedicine for spine care may be a preferable option for a subset of patients into the future.

Study Design: Narrative review. Objectives: Describe a comprehensive spine telemedicine examination. Methods: We discuss telemedicine examination techniques for commonly encountered spine conditions. Results: Techniques to evaluate gait, the cervical spine, the lumbar spine, adult spinal deformity patients, and adolescent scoliosis patients via telemedicine are described. We review limitations of the spine telemedicine examination and discuss special considerations such as patient safety and criteria for in-person assessment. Conclusions: While there are limitations to the spine telemedicine examination, unique strategies exist to provide important information to the examiner. Efforts have already been undertaken to validate and expand the capabilities of the spine telemedicine examination.

Study Design. Systematic review. Objective. The aim of this review is to present an overview of robotic spine surgery (RSS) including its history, applications, limitations, and future directions. Summary of Background Data. The first RSS platform received United States Food and Drug Administration approval in 2004. Since then, robotic-assisted placement of thoracolumbar pedicle screws has been extensively studied. More recently, expanded applications of RSS have been introduced and evaluated. Methods. A systematic search of the Cochrane, OVID-MEDLINE, and PubMed databases was performed for articles relevant to robotic spine surgery. Institutional review board approval was not needed. Results. The placement of thoracolumbar pedicle screws using RSS is safe and accurate and results in reduced radiation exposure for the surgeon and surgical team. Barriers to utilization exist including learning curve and large capital costs. Additional applications involving minimally invasive techniques, cervical pedicle screws, and deformity correction have emerged. Conclusion. Interest in RSS continues to grow as the applications advance in parallel with image guidance systems and minimally invasive techniques. IRB Approval. N/A.

Study Design: Retrospective cohort study. Objective: Spine surgery has been increasingly performed in the outpatient setting, providing greater control over cost, efficiency, and resource utilization. However, research evaluating the safety of this trend is limited. The objective of this study is to compare 30-day readmission, reoperation, and morbidity for patients undergoing lumbar disc arthroplasty (LDA) in the inpatient versus outpatient settings. Methods: Patients who underwent LDA from 2005 to 2018 were identified using the ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database. Regression was utilized to compare readmission, reoperation, and morbidity between surgical settings, and to evaluate for predictors thereof. Results: We identified 751 patients. There were no significant differences between inpatient and outpatient LDA in rates of readmission, reoperation, or morbidity on univariate or multivariate analyses. There were also no significant differences in rates of specific complications. Inpatient operative time (138 ± 75 minutes) was significantly ( P < .001) longer than outpatient operative time (106 ± 43 minutes). In multivariate analysis, diabetes ( P < .001, OR = 7.365), baseline dyspnea ( P = .039, OR = 6.447), and increased platelet count ( P = .048, OR = 1.007) predicted readmission. Diabetes ( P = .016, OR = 6.533) and baseline dyspnea ( P = .046, OR = 13.814) predicted reoperation. Baseline dyspnea ( P = .021, OR = 8.188) and ASA (American Society of Anesthesiologists) class ≥3 ( P = .014, OR = 3.515) predicted morbidity. Decreased hematocrit ( P = .008) and increased operative time ( P = .003) were associated with morbidity in univariate analysis, but not in multivariate analysis. Conclusions: Readmission, reoperation, and morbidity were statistically similar between surgical setting, indicating that LDA can be safely performed in the outpatient setting. Higher ASA class and specific comorbidities predicted poorer 30-day outcomes. These findings can guide choice of surgical setting given specific patient factors.

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