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Telemedical Support Using Smartphones for Spine Surgery in Low- and Middle-Income Countries.

Fabian Sommer¹, Francois Waterkeyn^1,2,3, Ibrahim Hussain¹

¹Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA.

Telemedicine Journal and E-Health : the Official Journal of the American Telemedicine Association

|May 1, 2023

Summary

Smartphones offer potential for telemedical support in low- and middle-income countries (LMICs) for spine surgery. However, current smartphone imaging limitations prevent reliable identification of critical anatomical structures during surgery.

Keywords:

global health neurosurgery orthopedics telemedicine telesurgery

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Area of Science:

Neurosurgery
Telemedicine
Medical Technology

Background:

Low- and middle-income countries (LMICs) face significant healthcare access challenges, particularly for time-critical specialties like spine surgery.
Limited transportation and infrastructure hinder access to specialized medical care in remote regions.
Advancements in smartphone technology present opportunities for remote telemedical support.

Purpose of the Study:

To assess the feasibility of using commercially available smartphones for telemedical support in spine surgery in LMICs.
To evaluate the image quality of smartphones for pre-operative and intra-operative surgical assessments.

Main Methods:

A feasibility study was conducted with a neurosurgical institution in East Africa using a smartphone.
Pre-operative image quality was assessed using test charts (resolution, contrast, brightness, color).
Intra-operative image quality was evaluated by visualizing an instrument table, surgical field, and X-ray screen, with subjective ratings by reviewers.

Main Results:

Smartphone image quality for test charts was high (97%±5 on white, 84%±5 on black backgrounds), with excellent color, contrast, and brightness reproduction.
Intra-operative visualization of the instrument table was excellent.
Visualization of the operative site (1.5±0.5) and X-ray screen (1.5±0.9) lacked sufficient detail for confident identification of anatomical structures.

Conclusions:

While smartphones offer high imaging and processing capabilities, current technology is insufficient for reliable intra-operative visualization of critical anatomical structures in spine surgery.
Smartphones show potential for supporting surgical procedures in LMICs, particularly in other surgical fields where detailed visualization is less critical.