Spinal Anesthesia for Awake Spine Surgery
Awake spine surgery, a ground-breaking approach in modern surgical practices, challenges traditional norms by allowing patients to remain conscious during certain spinal procedures 1. In awake spine surgery, patients are consciously engaged throughout the procedure, providing real-time feedback to the surgical team and promoting a more personalized approach to care. This innovative technique is particularly advantageous for certain spinal surgeries, such as deformity corrections, where maintaining neurological function is critical. Spinal anesthesia is a key component of awake spine surgery.
Central to the success of awake spine surgery is the administration of spinal anesthesia. Unlike general anesthesia, which induces a state of unconsciousness, spinal anesthesia targets a specific region of the spine, numbing the part of the body served by nerves in that region of the spine while allowing the patient to remain awake and responsive. This technique not only minimizes the risks associated with general anesthesia but also offers distinct advantages in terms of patient collaboration and intraoperative monitoring.
A recent meta-analysis demonstrated the benefits of spinal anesthesia in awake spine surgery relative to general anesthesia in patients who had undergone various lumbar procedures 2. Benefits may include reduced duration of anesthesia, cost, operative time, and postoperative complications. It is also associated with reduced cardiopulmonary complications and opioid consumption 3. Finally, spinal anesthesia for awake spine surgery avoids the negative systemic effects of general anesthesia. Relatedly, with the absence of general anesthesia-related grogginess, patients undergoing awake spine surgery often experience a quicker recovery. This rapid recovery facilitates early mobilization and may contribute to shorter hospital stays 4. Large prospective trials are necessary, however, to confirm these promising data.
Despite the potential for improving outcomes, awake spine surgery has been met with a certain degree of resistance and has yet to become widely adopted in many healthcare institutions. A recent manuscript sought to lay forth the fundamental steps critical to the initiation of an awake spine surgery program 3. The authors highlight that the development of an awake spine surgery program is a challenging one but one that has many advantages to patients and healthcare systems.
The success of awake spine surgery with spinal anesthesia hinges on appropriate patient selection and thorough preoperative education. Patients must be carefully screened to ensure they are suitable candidates for the procedure. Indeed, although no direct studies have identified the ideal candidate, there are certain contraindications. The contraindications for awake spine surgery include surgeries involving more than two vertebrae, surgeries with unpredictable durations, and patients with risks of respiratory compromise, among others 3.Additionally, educating patients about the awake spine surgery process, the role of spinal anesthesia, and the expected outcomes is crucial in fostering informed decision-making and allaying any anxieties.
In conclusion, awake spine surgery with spinal anesthesia allows patients to actively participate in their surgical experience, enhancing safety, reduces recovery time, and provides an alternative to traditional general anesthesia.
The evolving landscape of awake spine surgery will continue to stimulate ongoing research to refine techniques and expand indications, however. As technology advances, innovative approaches to intraoperative monitoring, pain management, and patient experience are likely to shape the future of awake spine surgery.
References
1. Awake spinal surgery: A paradigm shift in neurosurgery – Mayo Clinic. Available at: https://www.mayoclinic.org/medical-professionals/neurology-neurosurgery/news/awake-spinal-surgery-a-paradigm-shift-in-neurosurgery/mac-20531255. (Accessed: 30th January 2024)
2. Perez-Roman, R. J., Govindarajan, V., Bryant, J. P. & Wang, M. Y. Spinal anesthesia in awake surgical procedures of the lumbar spine: a systematic review and meta-analysis of 3709 patients. Neurosurg. Focus 51, (2021). doi: 10.3171/2021.9.FOCUS21464.
3. Waguia, R. et al. How to start an awake spine program: Protocol and illustrative cases. IBRO Neurosci. Reports 13, 69 (2022). doi: 10.1016/j.ibneur.2022.05.009
4. A Guide to Awake Spine Surgery – Desert Institute for Spine Care. Available at: https://www.sciatica.com/blog/what-is-awake-spine-surgery/. (Accessed: 30th January 2024)