To the Editor:Clinics around the world are adapting to the novel coronavirus 2019 (COVID-19) pandemic employing telemedicine to serve the needs of their patients. Traditionally, telemedicine has been driven by providing healthcare to rural, underserved populations and has involved medical specialties that are thought to be more suitable for remote consultation, like psychiatry and dermatology. 1 During the COVID-19 pandemic, surgeons have started to implement remote clinic visits to meet the needs of their patients while practicing social distancing. Our aim is to discuss the unique challenges of caring for neurosurgical spine patients via telemedicine during the COVID-19 pandemic, and to define the opportunities for telemedicine as an outpatient care adjunct in the post-COVID-19 world.Neurosurgical telemedicine literature is sparse and primarily relates to triaging trauma in rural settings, 2 managing routine follow-up patients, 3 and analyzing the socioeconomic benefit for patients traveling long distances. 4 To meet the needs of the spine patient population, we must learn how to best incorporate telemedicine into spine care by (1) defining regulatory requirements, (2) implementing system-wide protocols centered around appropriate telemedicine technology, (3) structuring the clinic visit to best optimize telemedicine technology, and (4) understanding the benefits and limitations of telemedicine. REGULATORY REQUIREMENTSKey changes have been made to pre-COVID-19 telemedicine regulatory requirements in an effort to facilitate rapid implementation of telemedicine clinic visits across all medical specialties (see Table 1). Prior to the pandemic, healthcare providers had to be licensed in the state where the patient was located and Medicare/Medicaid covered only remote patient visits that occurred from eligible sites, which included offices, clinics, and hospitals, but not homes. 5 Currently, emergency waivers from governmental agencies now allow healthcare providers to see patients from out of state (though not all), telemedicine visits from home are now reimbursable, videoconferencing with non-Health Insurance Portability and Accountability Act (HIPAA)-compliant applications (such as FaceTime and Facebook Messenger) is acceptable, and prescriptions for controlled substances are now possible without a prior in-person evaluation. 5 Most private insurers have followed suit with the government and are allowing reimbursement for telemedicine visits.

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These data suggest that OS can be safely performed if appropriate precautions and patient selection are followed. Data such as these will help determine health care policy to maximize patient safety.