365 Awake Spine Surgery for Traditionally Poor Surgical Candidates: An Illustrative Cohort

Abstract

INTRODUCTION: Annually, hundreds of thousands of patients undergo surgery for degenerative spine disease (DSD). This represents only a fraction of patients that present for surgical consideration. Procedures are often avoided due to comorbidities that make patients poor candidates for general anesthesia (GA) and its associated risks. With increasing interest in awake surgery under spinal anesthesia (SA), the authors have observed that SA may facilitate spine surgery in patients with relative contraindications to GA. METHODS: Case logs of a single surgeon were reviewed, and patients undergoing spine surgery with SA were identified. Within this group, patients were selected that were only able to receive surgery under SA due to their relative contraindications to GA. For this final cohort, the medical records were consulted to report demographic information, as well as patient outcomes. RESULTS: 8 patients were identified who were only able to receive lumbar spine surgery for DSD under SA due to their relative contraindications to GA. Comorbidities included octogenarian status, obesity, and chronic health conditions such as Parkinson’s and ischemic heart disease. The cohort was 25% female with a mean age of 72.9, a mean BMI of 30.1 kg/m2, and a mean ASA score of 3.0. The average procedure duration was 142.13 minutes. Mean time to ambulation was 23.18 hours and the average hospital length of stay was 1.67 days. The patients used an average of 28.69 morphine milligram equivalents for pain control in the operative and postoperative days. CONCLUSIONS: For patients with symptomatic, refractory DSD and relative contraindications to GA, SA may facilitate safe surgical intervention with excellent outcomes.