Anesth Pain Med.  2023 Oct;18(4):349-356. 10.17085/apm.23031.

Spinal anesthesia in elective lumbar spinal surgery

• Hernandez NS
• Begashaw B
• Riesenburger RI
• Kryzanski JT
• Liu P

• KMID: 2550914
• DOI: http://doi.org/10.17085/apm.23031

Abstract

Spinal anesthesia (SA) is gaining recognition as a safe and efficacious regional alternative to general anesthesia for elective lumbar surgery. However, unfamiliarity with management issues related to its use has limited the adoption of awake spine surgery, despite its benefits. Few centers in the United States routinely offer SA for elective lumbar surgery, and a comprehensive workflow to standardize SA for lumbar surgery is lacking. In this article, we examine recent literature on the use of SA in lumbar surgery, review the experience of our institution with SA in lumbar surgery, and provide a cohesive outline to streamline the implementation of SA from the perspective of the anesthesiologist. We review the critical features of SA in contemporary lumbar surgery, including selection of patients, methods of SA, intraoperative sedation, and management of several important technical considerations. We aimed to flatten the learning curve to improve the availability and accessibility of the technique for eligible patients.

Keyword

Spinal anesthesia; Neuroanesthesia; Spine surgery; Awake spine surgery; Intrathecal bupivacaine

Figure

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  Fig. 1. Patient selection and optimization algorithm for SA. SA: spinal anesthesia, BMI: body mass index, GEA: general endotracheal anesthesia, OSA: obstructive sleep apnea, CPAP: continuous positive airway pressure.

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