Dr. Sharan, founder of Edison, N.J.-based Spine and Performance Institute, joined the “Becker’s Spine and Orthopedic Podcast” to discuss his outlook on awake spine surgery.
Note: This is an edited excerpt. Listen to the full conversation here.
Question: As a leader in awake spine surgery, what’s the state of that in your practice and in the specialty overall?
Dr. Alok Sharan: Awake spine surgery initially came out of a desire of doing spine surgery without general anesthesia. That’s how it started, because I had a patient who had actually requested this more than 10 years ago. Now awake spine surgery has really evolved into the development of what we call a rapid recovery protocol. When someone comes to me for a spinal fusion, we’re able to do their surgery in a minimally invasive fashion, through a small incision using local anesthesia and sedation, and discharge them home on the same day with Motrin and Tylenol. Awake spine surgery for us is an opioid-free, same day spine procedure, which has just been really exciting to work on over the past few years.
We’ve had many patients come to us not just from our local region, but also from out of state because they realize that general anesthesia does have some side effects, and if it’s possible to have the surgery without it, they’re going for [awake spine surgery].
What’s been exciting for me to see as the field evolves is the number of practitioners throughout the country who are also observing the same issues and reaching out to me and asking me about our protocols. My colleague, Muhammad Abd-El-Barr MD, PhD, is spearheading the publication of a book on awake spine surgery, and it should be out this fall.
Q: Can you dive in a bit deeper into these reactive recovery protocols?
AS: I’ve come to a couple different conclusions as we continue to develop our protocols. It’s pretty clear to me that when a patient has a spine problem, they want to come to you and in the least invasive fashion have their problem fixed and be independent as soon as possible. When we started doing awake spine surgery, we noticed that if you go from using general anesthesia to just spinal anesthesia, that your length of stay goes down by 50%. As we started adding in other items, such as regional blocks and markings that last for about 24 to 48 hours, we noticed that patients were mobilizing quicker after surgery and requiring less pain meds. We got to a pretty efficient point where we were doing spinal fusion surgery and sending them home the same day.
Once we achieved a same day discharge after spinal fusion surgery we wondered, “What’s the next big challenge that we can go after?” The next big challenge was to go after the opioid problems. We all know about the problems of opioids and spinal fusion surgery, and I’ve heard about multimodal analgesia and different kinds of protocols people are using.
But in speaking to my colleagues who do orthopedic sports medicine, I appreciated from them the value of nutrition and nutritional optimization prior to surgery. Now they’re doing it for their athletes. I thought about how we can transpose that knowledge to our spine patients. What we started doing is prior to surgery we nutritionally optimize the patients using an antiinflammatory amino acid along with an amino acid supplementation. What we’re seeing now is that by reducing the inflammation prior to surgery, and to some degree helping build up their muscles, the patients require less pain meds after surgery. When we started realizing that, we realized that these patients actually don’t need opioids. By using knowledge of the work that my colleagues are doing on athletes and bringing it over to spine surgery, we saw that basically we can do opioid-free spinal fusion surgery and send them home the same day.
