Awake Minimally Invasive Surgery Transforaminal Lumbar Interbody Fusion Under Spinal Anesthesia: Screw Placement...

Area of Science:

• Neurosurgery
• Spinal Surgery
• Anesthesiology

Background:

• Minimally invasive surgery (MIS) offers advantages for spinal fusion.
• Awake surgery under spinal anesthesia is an emerging technique for MIS transforaminal lumbar interbody fusion (TLIF).
• Assessing pedicle screw accuracy and patient outcomes in this setting is crucial.

Purpose of the Study:

• To evaluate the accuracy of pedicle screws placed during awake MIS-TLIF under spinal anesthesia.
• To analyze patient outcomes at a 1-year follow-up after awake MIS-TLIF.

Main Methods:

• Retrospective analysis of patients undergoing awake MIS-TLIF under spinal anesthesia (February 2020 - February 2022).
• Gertzbein-Robbins classification used for pedicle screw accuracy assessment.
• 100 pedicle screws in 24 patients analyzed, with follow-up including computed tomography and symptom reporting.

Main Results:

• 99% of pedicle screws achieved Gertzbein-Robbins grade A accuracy.
• Low median estimated blood loss (35 mL) and short length of stay (0 days), with 54% discharged same day.
• No pseudarthrosis observed at 1-year follow-up on CT scans.

Conclusions:

• Awake MIS-TLIF under spinal anesthesia achieves high pedicle screw accuracy.
• This technique leads to significant symptom improvement at 1-year follow-up.
• The procedure is associated with minimal blood loss and short hospital stays.