893 - A retrospective chart review: Outcomes of lumbar epidural steroids injections in telemedicine patients without an in-person assessment.

Objectives:
The success of a transforaminal epidural steroid injections (TFESI) is dependent on accurate localization of the symptomatic spinal segment. There is limited data on if telemedicine assessments alone are sufficient for procedural planning and accuracy of diagnosis. The objective of this study is to determine treatment outcomes in patients who had scheduled lumbar TFESI based exclusively on telemedicine visits.



Design:
This is a retrospective observational cohort study completed at an academic spine practice. Charts with new telemedicine encounters between April 1, 2020 and April 1, 2021 were reviewed. Inclusion criteria include patients with no prior in-office evaluations that were scheduled for a one or two level lumbar TFESI with an MRI less than a year old.

Results:
A total of 229 patients met inclusion criteria. Mean age was 59 with 61% female [140], 39% male [89]. 71.6% of patients achieved > 50% pain relief [164/229] of at least 2 weeks duration. Patients that did achieve > 50% pain relief were generally satisfied and had improved functional outcomes. (P < 0.001). 8.3% [19/229] of the patients had a subsequent procedure change. Most common changes were in the levels injected [53%, 10/19], changes in laterality [32%, 6/19] or coexisting pain generators resulting in hip intervention [16%, 3/19], facet intervention [11%, 2/19], or greater trochanteric bursitis injection [5%, 1/19]. One case was due to coexisting thoracic myelopathy as the predominant pain generator that required surgery.



Conclusions:
Scheduling lumbar TFESIs for patients solely through telemedicine visits has demonstrated similar outcomes in pain relief, comparable to those seen in traditional settings. This, coupled with minimal procedural changes, suggests that telemedicine is as accurate as traditional evaluations for pre-procedural planning of lumbar TFESIs. Additional considerations during virtual examinations should include potential coexisting hip and gluteal pathology, as well as any concerns for myelopathy.