Perioperative Outcomes in Endoscopic Lumbar Decompression Surgery Under Spinal and General Anesthesia: A Matched...

The prevalence of endoscopic techniques in lumbar spine surgery is increasing. While general anesthesia (GA) remains the standard approach, spinal anesthesia (SA) is a promising alternative.

Whereas much of the existing literature examines the use of SA in traditional surgical techniques, this study aims to compare perioperative outcomes in patients undergoing endoscopic lumbar spine surgeries under GA and SA.

We retrospectively analyzed data from 22 patients who underwent elective endoscopic lumbar spine surgery under SA and were matched 1:1 to patients undergoing similar surgeries under GA, based on the number of spinal levels operated on.

Key outcomes examined included incidence of intraoperative hypotension, the Postoperative Morbidity Survey Score (POMS), operating theater (OT) turnover time, and postoperative nausea and vomiting (PONV). These were analyzed using multiple logistic regression, Wilcoxon signed-rank tests, and McNemar tests.

Forty-four patients were included. SA was associated with lower rates of intraoperative hypotension (odds ratio: 0.0583, P=0.00469), shorter OT turnover times (mean: 79.9 min vs. 116 min, P=0.00632) and lower POMS scores (mean: 0 vs. 0.227, P=0.0369). PONV occurred exclusively in the GA group in 4/22 patients (18.2%), although the difference was not statistically significant. Use of SA was also associated with slightly higher pain scores (mean score out of ten, 1.91 vs. 0.818, P=0.0138), but lower rates of total perioperative opioid consumption and intravenous analgesic adjunct administration.

SA for endoscopic spine surgery was associated with reduced intraoperative hypotension, lower perioperative morbidity, shorter OT turnover times and decreased opioid consumption. Despite its benefits, SA is limited by procedure duration, complexity, and the risk of emergency conversion to GA. Airway management challenges in the prone position highlight the need for careful patient selection and contingency planning.