Spinal anesthesia for lumbar spine surgery is a technique that provides excellent operating conditions and patient satisfaction. The ability to avoid a general anesthetic and the requisite management of the airway is attractive to many patients. In contrast to the frequently-challenging period after emergence with spine surgery under general anesthesia, spinal anesthetic provides a ‘soft landing’ in the early postoperative period as the block of the lumbar area recedes slowly. In this lecture, I will discuss our experience with awake lumbar spine surgery under spinal anesthesia and provide perspective on several important considerations including:
What does ‘awake spine surgery’ really mean? Are all patients wide awake? Is some sedation ok? What sedative agents/plans are appropriate and safe in this setting?
Patient selection: Who CAN get awake spine surgery? Who should NOT be considered for awake spine surgery?
Communication with patient and surgeon: How to set expectations ahead of time with the patient, the surgeon, and the perioperative team?
Technique: The how, where, when and what of our intraoperative regimen with a recipe for success
Pitfalls: What can go wrong in awake spine surgery? How to predict and prepare for these
Outcomes: Why do we do this? Are we really making a difference? Here we discuss some of the important data that support the use of awake spine surgery in selected patients.