An emerging specialty in spine neurosurgery is the Awake Spine surgical protocol. However, regional anesthesia is not new for certain surgical procedures. A sharply increasing number of neurosurgeons are having successful results from the implementation of awake (regional) anesthesia protocols for minimally invasive spine surgery.
What is Awake Spinal Surgery?
Awake spinal surgery is simply surgery with regional anesthesia rather than general anesthesia.
General anesthesia puts the patient in a state of total sleep with no awareness of what’s going on around them.
Regional anesthesia numbs a specific part of the body to allow a surgical procedure to be done there without pain. Types of regional anesthesia include
- Spinal anesthesia or subarachnoid block,
- Epidural anesthesia, and
- Nerve blocks.
Regional anesthesia is commonly referred to as conscious sedation or twilight sedation.
Except for the different anesthesia protocols, the surgical procedures are the same.
Why Would You Like Awake Spine Surgery?
Awake spine surgery is preferable to general anesthesia because
- The recovery time is shorter.
- You will be up and around earlier.
- There is less pain immediately after surgery.
Full recovery time after awake spine surgery is usually relatively short compared to general anesthesia. Patients are fully recovered within a few days compared to many days or weeks for general anesthesia.
Experience shows that awake surgery patients are up and walking within hours after spinal fusion surgery. Hospitalization is relatively short with some patients ready to go home the same day.
Pain relief with awake protocols usually endures for 24 to 48 hours after surgery. Spinal fusion patients with general anesthesia must start on pain relief drugs immediately upon return to their hospital bed from the recovery room.
In addition, the pros of awake spine surgery include:
- It results in less postoperative fatigue, nausea, urinary retention, and spinal headaches.
- It has less postoperative delirium for which elderly patients are especially at risk. Delirium symptoms include confusion, memory loss, or other mental states that lasts about a week.
Is Awake Spinal Surgery New?
Awake spinal surgery is revolutionary for spinal fusion procedures but regional anesthesia is not experimental. Regional anesthesia has been used for years for
- Cesarean section and other gynecological procedures.
- Childbirth and labor pain relief.
- Craniotomies (removing part of the skull for brain surgery).
- Orthopedic surgery on extremities.
- Bladder and urinary tract surgery.
The safety and effectiveness of regional anesthesia for back surgeries are supported by extensive clinical experience. Dr. Kingsley Abode-lyamah, a Mayo Clinic neurosurgeon observes
“This is a real paradigm shift in neurosurgery. Our studies are showing that spinal anesthesia not only is safe but also offers real benefits for patients. There has been a perception that patients would not be willing to undergo this type of surgery awake. But in our experience, spinal anesthesia improves patients’ overall satisfaction.”
Selection of Best Candidates for Awake Spine Surgery
Although awake spine surgery is relatively new there has been enough experience to develop a profile of a patient suitable for it.
The ideal candidate has no history of anxiety, no airway obstruction (e.g. sleep apnea), and no lumbar spinal pathology below the conus medullaris level (near the first two lumbar vertebrae).
For awake procedures, spinal fusions should be limited to 1 or 2 levels and decompressions limited to 3 levels.
Awake Spine Surgeons
Among the growing number of neurosurgeons with experience with the relatively new awake spine surgery protocol the Awake Spine Surgery program in Matawan, New Jersey is a prominent example. More than 100 patients have had a successful Awake Spinal Fusion from the experts at Awake Spine Surgery.