Anesthesiologist attitudes toward Spinal anesthesia in lumbar spine Surgery: National survey findings and...

Spinal anesthesia (SA) is a safe alternative to general anesthesia for lumbar spine surgery that is not yet routinely offered at most centers. While prior work has examined surgeon perspectives on the modality, little has been published about anesthesiologists' attitudes toward SA on a national scale or the factors influencing its adoption in spine surgery. Given that many patients prefer regional approaches when available, understanding anesthesiologists' perspectives is essential to support patient-centered perioperative decision making. We assessed anesthesiologists' perspectives on SA use in lumbar spine surgery and identified barriers to its broader adoption.

A survey was distributed to members of the American Society of Anesthesiologists. Anesthesia expertise, practice setting, and subspecialty were recorded. Experience with administering SA and opinions on its feasibility were elicited. Univariate analysis employed Pearson's Chi-Square Test in Stata. Multivariate logistic regression models were utilized in R to assess predictors of attitudes toward use of SA in spine surgery.

Of 516 total respondents, 49 % report 20 + years of experience, 31.4 % with 11-20, and 19.6 % with 1-10. Overall, 21 % reported utilization of SA - of which 16 % were anesthesiologists with 1-10 experience years, 16 % with 11-20, and 26 % with 20+ (p = 0.0196). Nineteen percent have never heard of SA being used for spine surgery - of which 32 % report 1-10 experience years, 19 % with 11-20, and 13 % with 20+ (p = 0.0002). Greater experience, prior exposure, and interest level predicted feasibility perceptions (p < 0.005). When using multivariate regression models, only prior experience with use of SA during lumbar spine surgery remained an independent predictor of favorable attitudes. Airway management in the prone position and surgery duration variability were the most reported concerns. Less experienced anesthesiologists cited knowledge gaps and medicolegal concerns.

Spinal anesthesia is a safe, patient-centered option for lumbar spine surgery but remains underutilized. A key barrier to broader adoption is variable familiarity and comfort among anesthesiologists. Addressing this gap could broaden anesthetic options and better support patient involvement in decision-making.