J Minim Invasive Spine Surg Tech.  2024 Apr;9(1):37-45. 10.21182/jmisst.2023.01123.

The Growing Trend of Degenerative Spine Surgery Under Spinal Anesthesia in the Elderly: Empowering Patient Safety: A Series of 83 Cases

• Nair VV
• Kundnani V
• Patel J
• Chodavadiya S
• Patil M
• Dewnany N

• KMID: 2562197
• DOI: http://doi.org/10.21182/jmisst.2023.01123

Abstract

Objective
Awake spine surgery has improved patient outcomes in common orthopaedic procedures. Integrating it into spine surgery is of interest to surgeons since it may reduce the difficulties and complications associated with general anaesthesia. The demand for safe spine surgery is rising due to healthcare improvements and increasing ageing population. This study aimed to assess the safety and feasibility of spine surgery under spinal anesthesia for elderly patients aged 65 and older.
Methods
In a retrospective review, 83 lower lumbar spine surgeries performed under spinal anesthesia by a single surgeon at a single hospital from 2015 to 2019 were examined. All procedure-related data was collected prospectively for analysis. This study explored demographic characteristics, surgical features, perioperative concerns, and anesthesia-related obstacles in spine surgery under spinal anaesthesia.
Results
This study included 83 patients aged 65 years and older. Following follow-up, visual analogue scale and Oswestry Disability Index scores considerably improved (p<0.05). Patients in the American Society of Anesthesiologists physical characteristics classification grade II had the highest count. The most common level was L4–5. About 7.2% of patients needed multiple spinal procedures. The average induction time was 20.2±9.6 minutes. The average intraoperative operation lasted 84.0±17.20 minutes. The shifting-out process took 7.95±2.10 minutes to start. The mean intraoperative arterial blood pressure was 70.7±10.8 mmHg, and the mean heart rate was 69.0±7.2 beats per minute. The average postoperative analgesia initiation time was 79.9±7.7 minutes. The average postoperative stay was 3.02±0.83 days. In 10.8% of individuals, cerebrospinal fluid was found. 1.2% of patients experienced postoperative hypotension, 12% experienced nausea and vomiting. Infection occurred in 2.4% of patients, and 14.5% experienced post-operative urinary retention.
Conclusion
This case series shows that older patients can undergo lumbar fusion, decompression surgeries under spinal anesthesia with a skilled anaesthesia team. Additionally, spinal anaesthesia substantially minimised dangers and concerns related with general aanaesthesia.

Keyword

Awake spine surgery; Geriatric; Spinal anesthesia; Lumbar spine; Fusions; Decompression