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Awake spine surgery: An eye-opening movement.

Brian Fiani1, Taylor Reardon2, Jacob Selvage2

  • 1Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, United States.

Surgical Neurology International
|June 4, 2021
PubMed
Summary

Awake spine surgery offers benefits like faster recovery, especially for lumbar laminectomies. However, patient selection is crucial, considering factors like BMI and mental health for optimal outcomes.

Keywords:
Conscious sedationEnhanced recovery after surgeryMinimally invasiveNeural feedbackNeuroanesthesia

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Area of Science:

  • Neurosurgery
  • Spinal Surgery
  • Anesthesiology

Background:

  • Awake surgery, historically limited to craniotomies in neurosurgery, is increasingly adopted in spinal surgery.
  • Spinal surgeons are exploring regional anesthesia techniques for awake spine surgery to reduce patient costs and improve recovery.
  • Common awake spine procedures include laminectomies, anterior cervical discectomy and fusions (ACDFs), lumbar fusions, and dorsal column (DC) stimulator placement.

Purpose of the Study:

  • To review the current literature on awake spine surgery techniques and outcomes.
  • To compare the efficacy and safety of awake spine surgery versus general anesthesia for various spinal procedures.
  • To identify patient selection criteria and limitations for successful awake spine surgery.

Main Methods:

  • An extensive literature review was conducted using the PubMed database.
  • Articles were identified using the search term "awake spine surgery" without date restrictions.
  • Relevant articles were screened for full-text and English language availability.

Main Results:

  • Awake lumbar laminectomies showed shorter operating times, less nausea, and fewer spinal headaches compared to general anesthesia.
  • Awake lumbar fusions reported similar outcomes with better postoperative function and fewer anesthetic side effects.
  • Awake DC stimulator placement allows real-time feedback but has higher failure rates (29.7%) versus general anesthesia (14.9%) due to patient movement.

Conclusions:

  • Awake spine surgery is beneficial for select patients unable to tolerate general anesthesia.
  • Patient selection is critical, requiring tolerance for prone positioning, a healthy airway, and absence of mental health conditions.
  • Further research is needed to establish long-term efficacy and refine indications for awake spine surgery.