314 Spinal Versus General Anesthesia for Lumbar Spine Surgery: Prospective Analysis of Quality of Life, Postoperative Fatigue and Cognitive Dysfunction

Abstract

INTRODUCTION: Low back pain is the leading cause of years lost to disability worldwide, and this burden is increasing as our population ages. Postoperative fatigue and postoperative cognitive dysfunction (POCD) commonly affect patients during their recovery period and diminish their quality of life. There has recently been increasing interest in the use of spinal anesthesia (SA) for lumbar spine surgery. To date the literature that has compared spine surgery under SA versus general anesthesia (GA) has been focused exclusively on safety, perioperative outcomes and costs. METHODS: We conducted a prospective non-randomized study in patients undergoing elective lumbar spine surgery under SA or GA by a single surgeon. Fatigue was assessed with a fatigue VAS scale (0-10) and with Chalder Fatigue Scale (CFQ); quality of life with the Medical Outcomes Study 12-item Short Form (SF-12); differences in cognition with the Mini-Mental State Exam(MMSE). Patients were assessed before the surgery to acquire their baseline and again 1 month after surgery. RESULTS: Fifty patients completed the study, 25 underwent surgery under spinal and 25 under general anesthesia. The groups were homogeneous for baseline clinical characteristics; with no differences in preoperative baseline fatigue, quality of life and cognition, and physical and mental components of the SF-12 between the SA and GA groups. At 1-month after surgery spinal anesthesia when compared to general anesthesia had better fatigue scores: i) fatigue VAS (2.9 ± 1.5 versus 5.6 ± 2.3, (p < 0.0001)); ii) fatigue CFQ (11.2 ± 3.1 versus 16.5 ± 3.9 (p < 0.0001)). At 1-month after surgery we observed a significant difference in the physical component of SF-12, spinal anesthesia having 38.8 ± 8.9 versus 29.4 ± 10.3 (p = 0.002). We did not observe significant postoperative differences in mental component of SF-12. There was no significant difference in MMSE at 1-month follow-up. CONCLUSION: At 1 month postop patients that underwent surgery under spinal anesthesia had less postoperative fatigue and better quality of life.