Identification and Triage of Emergent Spinal Pathology via Telemedicine: A Case Report

Abstract

Background There is little published literature concerning assessment of low-back pain (LBP) and emergent spinal pathologies via remote platforms. Case Presentation The patient was a 64-year-old female with complex medical history, referred to physical therapy for iliotibial band syndrome, reporting new onset severe LBP, bilateral leg pain/paresthesia, and urinary retention. Per the telemedicine examination, the American College of Radiology imaging guidelines for LBP, and the Guidance Document on Elective, Emergent, and Urgent Procedures for COVID-19 by the North American Spine Society (NASS), the patient was referred for magnetic resonance imaging and surgical consultation for suspected cauda equina syndrome. Outcome and Follow-Up Magnetic resonance imaging demonstrated multilevel lumbar spondylosis, facet hypertrophy, right lateral stenosis at L3–4, and a disc herniation resulting in severe central canal stenosis and cauda equina compression at L4–5. The patient subsequently underwent surgery to L4–L5 laminotomy and microdiscectomy and reported complete resolution of symptoms. Discussion Telemedicine may be effective for triaging patients with serious spinal pathology, as evidenced by the successful examination and identification of red flag symptoms, identification for advanced imaging, and referral for surgical consultation on an individual case basis. JOSPT Cases 2022;2(3):168–172. Epub: 21 June 2022. doi:10.2519/josptcases.2022.10820