What's the future of awake spine surgery?

Featured Insights

Awake spine surgery, which uses regional anesthesia instead of general anesthesia, has gained more interest and adoption in recent years, and the momentum is unlikely to abate. 

Three spine surgeons who perform awake procedures discuss where the technique stands in 2024 and what's ahead.

Note: Responses were edited for clarity and length.

Ernest Braxton, MD. Vail (Colo.) Summit Orthopaedics and Neurosurgery: Awake spine surgery may be suitable for certain types of spinal procedures, but in my practice I limit them to 1 or 2 level transforaminal lumbar interbody fusion procedures, interlaminar stabilization, and non-instrumented lumbar procedures. However, not all spine surgeries are appropriate for this approach, and the decision to use regional anesthesia should be made based on various factors, including the patient's medical history, the complexity of the surgery, and the preferences of the surgical team. As with any surgical procedure, awake spine surgery carries some risks, including the potential for discomfort or anxiety during the operation. Additionally, while regional anesthesia can provide effective pain relief, it may not completely eliminate all sensations, and patients should discuss their concerns and expectations with their spine surgeon before undergoing this type of surgery. It is also imperative that the spine surgeon have reliable times for how long the procedure will take. I try to limit my awake cases to two hours.

As of now, awake spine surgery, or spine surgery with regional anesthesia, is gaining attention and acceptance within the medical community. It's being recognized as a viable alternative to traditional spine surgery performed under general anesthesia, particularly for certain types of procedures and patient populations. My colleagues are increasingly exploring this approach for its potential benefits, such as reduced risks associated with general anesthesia, faster recovery times, and improved patient outcomes. This technique is particularly effective in the ASC.

In the next five years, I expect awake spine surgery to become more standardized and widely adopted among minimally invasive spine surgeons. Advances in regional anesthesia techniques and monitoring technology will likely further enhance its safety and effectiveness. Additionally, as more data on outcomes and patient experiences become available, surgeons will have a better understanding of the indications and limitations of awake spine surgery, leading to improved patient selection and surgical planning.

Moreover, ongoing research and innovation in surgical techniques and medical technology may expand the range of spine surgeries that can be performed with regional anesthesia. This could lead to the development of new minimally invasive procedures that are specifically designed for awake surgery, further optimizing patient care and recovery. Awake spine surgery could be particularly effective when contemplating endoscopic spine surgery.

Alok Sharan, MD. Spine and Performance Institute (Edison, N.J.): Awake spine surgery is progressing very well. We are seeing adoption of awake spine surgery across the U.S. and across the globe. Last year I had visitors from both England and the Middle East come to our practice to learn the technique.

In five years I believe there will be greater adoption of awake spine surgery, driven by patients asking for the technique. As more data gets presented and published patients will appreciate the rapid recovery that you can achieve when you avoid general anesthesia. In addition the cost savings of awake spine surgery will enable more of these cases to be completed in an ASC.

Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: Awake spine surgery was largely used for decompressive surgeries, laminectomies, discectomies, laminotomies in the lumbar spine just a few years ago. Today, awake lumbar fusions are becoming increasingly prevalent in the United States as the techniques have been standardized. Enabling this in my practice has resulted from standardization of our protocols, working closely with the anesthesia team to optimize the anesthetic regimen, and getting the surgical timing down to a science - under three hours skin to skin for any surgery being done awake. My team has been crucial in ensuring that this process is seamless. I use navigation and percutaneous fixation for my awake spinal fusion procedures. We will likely see the complexity of surgeries increase in the coming years, just as we have in the past. I intend to add multilevel lumbar fusions and lateral lumbar approaches to my awake practice in the coming years. I look forward to sharing best practices with other surgeons who are also innovating in this space.

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Webinars

Featured Whitepapers