Anesthesia for Lumbar Spine Surgery
Nearly 80% of Americans suffer from low back pain at some point in life, one quarter of whom experience chronic low back pain with persistent symptoms. Low back pain is now the leading cause of sick workdays and the most frequent cause of job-related disability 1. Low back pain may be linked to degenerative and autoimmune diseases, cord compression, scoliosis or acute spinal cord injuries – these conditions are all candidates for spinal surgery. An appropriate anesthesia regimen is vital to a smooth and successful lumbar surgery.
Various anesthetic regimens have been assessed for lumbar surgery. Initially, research found no difference between spinal and general. A 2005 case-controlled analysis comparing spinal and general anesthesia in a lumbar laminectomy suggested that spinal anesthesia was just as safe and effective as general anesthesia 2. While the authors concluded that this type of surgery could be performed using either anesthesia type, they did highlight that spinal anesthesia could result in a shorter anesthesia duration, decreased nausea, fewer medications (including anti-emetics and analgesics), and, relatedly, fewer complications.
In contrast, more studies have begun to find that spinal anesthesia outperforms general anesthesia across a number of metrics. First, a 2011 randomized clinical trial assessing spinal versus general anesthesia for elective lumbar spine surgery showed that spinal anesthesia was more effective than general anesthesia at providing postoperative analgesia and decreasing blood loss while maintaining perioperative hemodynamic stability 3. Further, it did not increase the incidence of adverse side effects.
A 2017 retrospective analysis also examining the efficiency of spinal versus general anesthesia for lumbar spinal surgery 4 revealed that spinal anesthesia, despite resulting in a longer stay in the post anesthesia care unit, was associated with a significantly shorter operative and anesthesia time, less blood loss, and a shortened overall hospital stay. Authors concluded that spinal anesthesia is the most effective and expedient anesthetic choice for patients undergoing elective lumbar laminectomy and/or diskectomy.
A 2019 single center study thereafter confirmed that, for routine lumbar surgery, spinal anesthesia, in contrast to general anesthesia, was linked to less drug administration, including of vasoactive agents 5. Reduced use of vasoactive agents results in a safer experience for patients, and less drug administration overall reduces risks linked to drug administration-related errors and pathogen transmission.
Doctors and patients at the University of California San Francisco are also reaping the multistakeholder benefits of spinal anesthesia. First, operative procedure times have been cut in half. Second, patients have needed less postoperative intravenous narcotics, minimizing the development or perpetuation of opioid addictions. Third, since general anesthesia is not required, patients do not need to be mechanically ventilated, thus eliminating any ventilator-related side effects. Finally, since patients are able to rapidly return home, they can swiftly return to their recreational and work activities. 6
Spinal anesthesia is emerging as a leading option by virtue of its safety and efficacy in the context of spinal surgery, including lumbar surgery in particular.
References
1. Low Back Pain Fact Sheet | National Institute of Neurological Disorders and Stroke. Available at: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet.
2. McLain, R. F. et al. Comparison of spinal and general anesthesia in lumbar laminectomy surgery: a case-controlled analysis of 400 patients. J. Neurosurg. Spine (2005). doi:10.3171/spi.2005.2.1.0017
3. Attari, M. A., Mirhosseini, S. A., Honarmand, A. & Safavi, M. R. Spinal anesthesia versus general anesthesia for elective lumbar spine surgery: A randomized clinical trial. J. Res. Med. Sci. (2011). doi:10.7176/jhmn/88-04
4. Pierce, J. T. et al. Efficiency of spinal anesthesia versus general anesthesia for lumbar spinal surgery: A retrospective analysis of 544 patients. Local Reg. Anesth. (2017). doi:10.2147/LRA.S141233
5. Deng, H., Coumans, J. V., Anderson, R., Houle, T. T. & Peterfreund, R. A. Spinal anesthesia for lumbar spine surgery correlates with fewer total medications and less frequent use of vasoactive agents: A single center experience. PLoS One (2019). doi:10.1371/journal.pone.0217939
6. Marks, R. Keeping Patients Awake During Spine Surgery is Cutting Recovery Time in Half | University of California San Francisco. Available at: https://www.ucsf.edu/news/2019/03/413446/spine-surgery-while-patients-are-awake-speeds-healing.