What's next for awake spine surgery? 3 predictions


Awake spine surgery avoids general anesthesia and intubation and uses a local anesthetic to let surgeons examine a patient's neurologic condition during surgery.

Benefits of awake spine surgery include faster recoveries, improved pain control and reduced postoperative nausea. It also eliminates the need to use intravenous narcotics and reduces the cost of stay. Only a handful of spine surgeons are currently performing the technique in the U.S.

Three of those surgeons discussed how awake spine surgery will evolve in the coming years:

Note: Responses were lightly edited for style and clarity.

Vijay Yanamadala, MD. Hartford (Conn.) Healthcare: I think that 10 years from now we're going to see awake spine surgery being done in the majority of cases. Patients will demand it. I think payers will also push in that direction, and we as surgeons will come to see its benefits, too — not only for our patients, but for our processes and ourselves. As it becomes more popular, the processes will be developed, and it will be smoother for broader adoption. 

Ernest Braxton, MD. Vail (Colo.) Summit Orthopaedics and Neurosurgery: I see it becoming more commonplace as patients demand a better experience with surgery, in the same way that we have seen regional anesthesia become very commonplace with total knee and total hip replacement surgery.

My mom recently had her knee replaced. It was performed with similar regional anesthesia blocks and a spinal anesthetic. She was awake for the operation, and she went home the same day after surgery. I have been applying this technique in my surgeries, and other surgeons around the country have adopted regional anesthesia for spine surgery.

What I'm really seeing is that the COVID-19 pandemic accelerated that growth because of a greater desire for the patient to be at home and out of the hospital. The hospital tends to have sicker patients. Outpatient surgery keeps beds available for higher-acuity patients, which has become extremely important. The pandemic has put a spotlight on the need to reserve hospital beds for the sickest patients. Fortunately, COVID-19 cases are decreasing in our community, but we still focus on minimizing the hospital stay. Anything we can do to accelerate recovery is worth considering. This patient stayed overnight and was discharged first thing in the morning. However, about 30 percent of my patients undergoing spine fusion go home the same day.

Alok Sharan, MD. NJ Spine and Wellness (East Brunswick, N.J.): I believe that regional anesthesia techniques in spine surgery will allow for faster recovery. A lot of the success of awake spine surgery has come from the adoption of these regional anesthetic techniques. For hip and knee replacements, regional anesthesia has been a game-changer. I am very excited about how these techniques will impact spine surgery.

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