Are awake fusions the future of spine surgery at ASCs?


Awake spinal fusion is a novel approach to spine surgery that fuses minimally invasive or endoscopic surgical techniques with contemporary anesthesia. 

The result? Ultimately, a safer and more efficient way of doing surgery, according to authors of a recent study in the Journal of Neurosurgery. Administering patients with local anesthetic allows surgeons to examine their neurologic condition during surgery and guard against damaging the patient's nerves or adjacent anatomy. 

It also eliminates the need to use intravenous narcotics and reduces the cost of stay — critical as the industry continues its shift toward value-based care.

"Awake spinal fusion is the next iterative advantage in minimally invasive spine surgery," said Alok Sharan, MD, director of spine and orthopedics at NJ Spine and Wellness in East Brunswick.

An early adopter of the procedure, Dr. Sharan developed a protocol that prepares patients to return home within 24 hours of surgery.

"It's an enhanced recovery protocol that in my mind, when you do it, leads to less pain, faster mobilization and an overall quicker recovery," Dr. Sharan said.

He estimates that fewer than 10 surgeons in the country are performing awake spinal fusions, which have been more widely adopted by surgeons in Europe. 

Dr. Sharan recently teamed with one of those surgeons — Muhammad Abd-El-Barr, MD, PhD, of Duke Spine Center in Durham, N.C. — to form a virtual study group where they share procedural best practices. 

Although the COVID-19 pandemic has stifled the procedure's adoption in the U.S., many surgeons believe that the procedure will play a key role in the future of spine care.

"I think there's a certain percentage of people who can really benefit from [transforaminal lumbar interbody fusions] and doing it awake," Brian Gantwerker, MD, a Los Angeles-based neurosurgeon who has considered incorporating the procedure after discussions with surgeons well-versed in the approach. 

"But heck, that's perfect for an ASC; four pedicle screws, two rods and an interbody," he said. "There's an implant cost issue, which I'm sure you could get down ... but I think there's a real sea of change that's going to happen in the next two to four years."

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