Transcription:
Getting Spine Care During the Coronavirus Pandemic

um sopScott Webb: Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. This episode is sponsored by the University of Maryland Spine Network. Connected by the renowned University of Maryland School of Medicine, the UM Spine Network is home to the States' leading spine experts. With convenient locations throughout the state, UM Spine Network physicians collaborate to create comprehensive care plans for patients across the full spectrum of care. When you work with a UM Spine Network physician, you can expect to receive the high quality evidence-based care that you deserve.

Today, we were discussing when and how to get spine care during the coronavirus pandemic. And here to help answer our questions is Dr. Kenneth Crandall. He's an Assistant Professor of Neurosurgery at the University of Maryland School of Medicine, neurosurgeon at UM St. Joseph Medical Center and a complex spine surgeon with Towson Orthopedic Associates.

This is Live Greater, a health and wellness podcast from the University of Maryland Medical System. I'm Scott Webb. So doctor, thanks so much for joining me today. What are the consequences of delaying spine care due to the pandemic?

Dr. Kenneth Crandall: That's a good question. I think there's a lot of consequences to delaying any sort of medical care, you know, during the pandemic, because ultimately if there's something that's bothering you or something that's on your mind, getting it checked out is a priority, because a lot of times it's nothing, but sometimes it can be something serious.

And from a spinal standpoint, things that we worry about are things that can potentially be issues that need to be addressed sooner, includes serious things such as cancer, fractures maybe due to trauma or osteoporosis. And it's unlikely for those things to occur. If you have back pain, chances are it's not cancer, but that's always a possibility. And talking to an expert is one way of helping to determine whether or not that's the case.

The other things that we worry about that need to be addressed potentially sooner rather than later are things where a neurologic deficit is involved and I'll explain what that is. You know, the spinal column or the spine protects the spinal cord and the nerves. And in disorders of the spine, there is the potential to have compression of the spinal cord, compression of the nerves. And that can lead to various problems such as weakness, um, you know, if it's a neck issue, it can lead to clumsiness of the hands or dropping things, or it could even lead to difficulty walking, uh, incontinence of stool or urine. And these issues can be progressive. And ultimately, if you have bad weakness in your muscles where you can't lift your foot up or you can't grip things with your hands, sometimes those conditions, if we don't treat them soon enough, can become permanent or irreversible.

And then sort of the other final category of reasons you may not want to delay your care is that if you have severe pain, you know. Often pain is not life-threatening, but if it's causing you to be debilitated to where you can't live your life, you can't function, stand, walk around, you know, then these are things that need to be addressed. And so the biggest thing is that if you delay some of these things, sometimes they can be irreversible.

Scott Webb: Yeah, no doubt. And there could be a variety of reasons why people might delay care, not the least of which is probably concerns about the pandemic. So what measures does the UM Spine Network have in place to ensure safe care access, you know, for patients during the pandemic?

Dr. Kenneth Crandall: Right. So, you know, this has been a learning experience for all of us. And, you know, we've sort of perfected, you know, our techniques over the past several months to provide safest patient experience as possible. And of course, that first starts with telemedicine visits. So, you know, we have a full range of telemedicine visits available, including video conferences, which are ideal because then we can actually look at each other face to face and we can perform a rudimentary physical exam, you know, over the video teleconferencing, but even phone telemedicine visits for people who may not have access to a video camera or may not have the technical know-how to do it. But even then I would say that it's pretty easy for even people who don't have a lot of experience with technology to do a video conference.

But, you know, there are some limitations to telemedicine. Obviously, we can't do a physical exam and sometimes subtle abnormalities, like subtle weakness or reflex changes can be found on physical exam, which is important. So of course, you know, we're also allowing people to come into our office. Um, but we take a lot of, uh, preventative steps and safety measures to prevent transmission of the virus. So, you know, everybody's wearing masks. Uh, we socially distance as much as possible, scheduling patients in a particular manner to avoid, you know, multiple people being in the waiting room at any one time or overlap within the exam rooms, et cetera. We ensure, you know, our patients are not sick by asking, you know, "Do you have a fever? Have you had any symptoms?" Same thing with our staff, you know, we're constantly being asked whether or not we have any symptoms and, if we do, we're not coming to work and we're getting appropriately tested.

We are limiting, uh, the number of people that can come with you to the appointment. Obviously, if you need someone to help you get around, or if you need some emotional support or something where, you know, you can bring a visitor, but we're trying not to, you know, have too many people around at any given time. And then, you know, also we're aggressively, uh, cleaning everything, you know, as much as possible in between patients and sanitizing our hands and everything. So, you know, we're learning, uh, as we go through this pandemic, but we're making it as safe as possible. And we want our patients to be able to get the care that they need.

Scott Webb: Yeah, definitely. And as you say, it has been a learning process, both for providers and for patients and, you know, still working out some of the kinks, but as you said, you know, doctors and offices now can kind of pivot. If the video visit is not working, then maybe we can just switch to telephone. And though the gold standard for some of this stuff may still be face to face, good to know that you're prepared for just about anything and really have a lot of safe measures in place, you know, regarding the pandemic. So when we talk about the pandemic and we talk about spine surgery, is it safe to have spine surgery right now?

Dr. Kenneth Crandall: The short answer is yes. Uh, you know, for a while during the pandemic, we were limiting the surgeries that we were performing to true, uh, emergencies, but we've gotten to the point right now where we're even performing elective operations, because again, we know more about how the coronavirus is transmitted, where the risk factors are and what we can do to limit those risk factors.

And, you know, ultimately, uh, you know, with any surgical procedure or anything in medicine, it's all about evaluating the risks and benefits. And this is really no different. So you can almost think of the coronavirus as an added risk to surgery. And, you know, every surgery has risks, infection, bleeding, damaging a nerve or something like that, and we can just add, you know, potential exposure to the coronavirus as an added risk.

But, you know, the risk of being exposed to COVID-19 in the hospital is low. In fact, uh, you know, I'm not aware of any patient, especially no patient of mine, that's contracted COVID-19 from being in the hospital for a spine operation. Even if it has occurred, you know, it's extremely rare and that's because of all the, uh, you know, precautions that we're taking such as, again, it's similar to what we talked about with the clinic. You know, everybody's wearing masks, socially distancing. All the patients that come into the hospital are tested for coronavirus prior to coming in, or if they come in as an emergency, they're being tested that day, with the employees in the hospital are all wearing masks and are not coming in if they're sick.

That being said, you know, you should have a conversation with your surgeon and you should weigh the risks and benefits. You know, if you're an older person who has a lot of risk factors, such as morbid obesity and diabetes, you know, things that could potentially make a sickness with coronavirus more serious, and your only symptom is back pain and you don't have neurologic deficits, then maybe that is a reason to consider delaying surgery, because, you know, again, there is still some risk out there. But if this is really altering your life, if you have neurologic deficits like weakness or spinal cord compression or some serious condition like spine cancer or something like that, then the benefits of surgery probably outweigh the risks.

Scott Webb: And we talked about the factors that help to determine if a patient should get spine surgery now or later, can we go through that just a little bit more in depth?

Dr. Kenneth Crandall: You know, again, it's similar to what we've talked about already in the sense that it comes down to the severity of the condition or the severity of the symptoms. If it's a progressive condition that's progressively getting worse, you know, over time, like if you have weakness and the weakness is getting worse or you have numbness and that's getting worse, you know, then it's probably something that needs to be done sooner rather than later. But if it's a chronic condition, uh, that's been going on for many years and hasn't really been progressively getting worse and it's not associated with weakness or a neurologic deficit or spinal cord compression or something, then that's probably something that's okay to wait. And then, you know, then there's the other categories of the more serious conditions such as cancer, trauma, fractures, things of that nature that also probably need to be addressed, you know, sooner rather than later.

Scott Webb: And doctor, if and when you recommend delaying surgery until after the pandemic, what do you recommend in terms of pain management for patients from home?

Dr. Kenneth Crandall: The ways of managing pain, you know, are really no different than they were when there wasn't a pandemic. Talk to your doctor, find out what's right for you. But, you know, there's all sorts of different medications that can be used to manage pain. Anti-inflammatories, muscle relaxers, nerve agents that can help with nerve pain like gabapentin, resting, you know, not performing strenuous activity, using heat or ice, doing home exercises. Uh, you know, these are all things that can be beneficial, but non-surgical therapies also still exist during the pandemic as well.

Physical therapy offices are open and are doing similar things to our clinics in terms of trying to keep people safe like social distancing, wearing masks, et cetera. Um, aquatic therapy places are also open. You know, all of these places have some limitations and things aren't the same as they used to be, but, you know, they have made these accommodations. And then of course, we often refer patients, you know, to pain management doctors who are also available, who are also seeing people via telemedicine visits and who are also scheduling patients for steroid injections and other non-surgical therapies that could potentially help you get through, you know, this time period that we're in right now where, you know, maybe delaying surgery for certain circumstances is safer than having it.

Scott Webb: Yeah, certainly. And I think that's a great way to end. You know, always a good idea when in doubt, check with the experts and good to know that the experts, you know, the providers on the other end right now, have really embraced telemedicine and virtual visits, and there are ways to screen and speak with patients from a distance, uh, safely. Really great stuff. Thank you so much for your time today and you stay well.

Dr. Kenneth Crandall: My pleasure. You too. Thanks.

Scott Webb: Learn more about the UM Spine Network at UMMS.org/spine. And thanks for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.