Awake Spinal Surgery

Awake spinal surgery is a growing technique in which patients remain conscious during spine procedures, relying on regional or local anesthesia instead of general anesthesia. “Over the past two decades, spinal surgeons have pushed for these techniques because they may provide reduced financial burdens on patients, faster recovery times, and better outcomes” (NIH, no author). Common procedures performed this way include laminectomies, discectomies, anterior cervical discectomy and fusions, lumbar fusions, and dorsal column stimulator placements. Patients who benefit most are those with a healthy airway, normal BMI, and no pre-existing anxiety or mental health conditions that might make staying difficult during the operation. 

The procedure works by using spinal or local anesthesia to numb the surgical area while the patient remains awake and communicative. At mayo clinic, procedures are completed within two to three hours, the typical duration of spinal anesthesia, and patients wear noise-canceling headphones or listen to music throughout. "This is a real paradigm shift in neurosurgery," says Dr. Kingsley Abode-Iyamah. "Our studies are showing that spinal anesthesia not only is safe but also offers real benefits for patients" (Abode-Iyamah). Research has shown that awake lumbar laminectomies result in shorter operating times, less postoperative nausea, lower rates of urinary retention, and fewer spinal headaches compared to procedures done under general anesthesia. 

Recovery after awake spinal surgery tends to be faster and smoother than traditional surgery, because patients avoid general anesthesia, they sidestep common side effects like memory loss, prolonged nausea, and cognitive fog, particularly in older adults. Studies show that patients who undergo awake procedures ambulate on average 7.8 hours earlier and have shorter hospital stays overall. Most patients report better postoperative function and a higher level of overall satisfaction with the experience, making awake spinal surgery an increasingly appealing option for appropriate candidates. 

Written by Malak Ibrahim at Incisionary

References

Awake spinal surgery: Simplifying the learning curve with a patient selection algorithm. Neurosurgical Focus, 51(6), E2. https://doi.org/10.3171/2021.9.FOCUS21433 (Image)

Fiani, B., Reardon, T., Selvage, J., Dahan, A., El-Farra, M. H., Endres, P., Taka, T., Suliman, Y., & Rose, A. (2021). Awake spine surgery: An eye-opening movement. Surgical Neurology International, 12, 222. https://pmc.ncbi.nlm.nih.gov/articles/PMC8168649/

Abode-Iyamah, K. (2022, April 23). Awake spinal surgery: A paradigm shift in neurosurgery. Mayo Clinic.https://www.mayoclinic.org/medical-professionals/neurology-neurosurgery/news/awake-spinal-surgery-a-paradigm-shift-in-neurosurgery/mac-205312558900.3390/biomimetics10120818