Spinal anesthesia for lumbar spine surgery correlates with fewer total medications and less frequent use of vasoactive agents: A single center experience

OBJECTIVE Spinal anesthesia (SA) is an alternative to general anesthesia (GA) for lumbar spine surgery, including complex instrumented fusion, although there are relatively few outcome data available. The authors discuss their experience using SA in a modern complex lumbar spine surgery practice to describe its utility and implementation. METHODS Data from patients receiving SA for lumbar spine surgery by one surgeon from March 2017 to December 2020 were collected via a retrospective chart review. Cases were divided into nonfusion and fusion procedure categories and analyzed for demographics and baseline medical status; pre-, intra-, and postoperative events; hospital course, including Acute Pain Service (APS) consults; and follow-up visit outcome data. RESULTS A total of 345 consecutive lumbar spine procedures were found, with 343 records complete for analysis, including 181 fusion and 162 nonfusion procedures and spinal levels from T11 through S1. The fusion group was significantly older (mean age 65.9 ± 12.4 vs 59.5 ± 15.4 years, p < 0.001) and had a significantly higher proportion of patients with American Society of Anesthesiologists (ASA) Physical Status Classification class III (p = 0.009) than the nonfusion group. There were no intraoperative conversions to GA, with infrequent need for a second dose of SA preoperatively (2.9%, 10/343) and rare preoperative conversion to GA (0.6%, 2/343) across fusion and nonfusion groups. Rates of complications during hospitalization were comparable to those seen in the literature. The APS was consulted for 2.9% (10/343) of procedures. An algorithm for the integration of SA into a lumbar spine surgery practice, from surgical and anesthetic perspectives, is also offered. CONCLUSIONS SA is a viable, safe, and effective option for lumbar spine surgery across a wide range of age and health statuses, particularly in older patients and those who want to avoid GA. The authors’ protocol, based in part on the largest set of data currently available describing complex instrumented fusion surgeries of the lumbar spine completed under SA, presents guidance and best practices to integrate SA into contemporary lumbar spine practices.

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Experiences of spinal anesthesia for previous lumbar spine surgery

European Journal of Anaesthesiology ◽

10.1097/00003643-200706001-00364 ◽

2007 ◽

Vol 24 (Supplement 39) ◽

pp. 99

Author(s):

S. Kim ◽

S J. Lee ◽

J H. Kim ◽

Y S. Shin

Keyword(s):

Lumbar Spine ◽

Spinal Anesthesia ◽

Spine Surgery ◽

Lumbar Spine Surgery

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Letter: Outpatient Cervical and Lumbar Spine Surgery is Feasible and Safe: A Consecutive Single Center Series of 1449 Patients

Neurosurgery ◽

10.1093/neuros/nyw032 ◽

2017 ◽

Vol 80 (2) ◽

pp. E185-E185 ◽

Cited By ~ 1

Author(s):

Sonia Gaucher ◽

Samir Bouam ◽

David Maladry ◽

Jean-Pierre Bethoux ◽

Henri-Jean Philippe

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Lumbar Spine Surgery ◽

Single Center

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Economic analysis of 90-day return to the emergency room and readmission after elective lumbar spine surgery: a single-center analysis of 5444 patients

Journal of Neurosurgery Spine ◽

10.3171/2020.6.spine191477 ◽

2021 ◽

Vol 34 (1) ◽

pp. 89-95

Author(s):

Marcel R. Wiley ◽

Leah Y. Carreon ◽

Mladen Djurasovic ◽

Steven D. Glassman ◽

Yehia H. Khalil ◽

...

Keyword(s):

Risk Factors ◽

Lumbar Spine ◽

Emergency Room ◽

Spine Surgery ◽

Administrative Databases ◽

Lumbar Spine Surgery ◽

Chronic Obstructive ◽

Multiple Chronic Conditions ◽

Single Center ◽

Patient Counseling

OBJECTIVEIn the future, payers may not cover unplanned 90-day emergency room (ER) visits or readmissions after elective lumbar spine surgery. Prior studies using large administrative databases lack granularity and/or use a proxy for actual cost. The purpose of this study was to identify risk factors and subsequent costs associated with 90-day ER visits and readmissions after elective lumbar spine surgery.METHODSA prospective, multisurgeon, single-center electronic medical record was queried for elective lumbar spine fusion surgeries from 2013 to 2017. Predictive models were created for 90-day ER visits and readmissions.RESULTSOf 5444 patients, 729 (13%) returned to the ER, most often for pain (n = 213, 29%). Predictors of an ER visit were prior ER visit (OR 2.5), underserved zip code (OR 1.4), and number of chronic medical conditions (OR 1.4). In total, 421 (8%) patients were readmitted, most frequently for wound infection (n = 123, 2%), exacerbation of chronic obstructive pulmonary disease (n = 24, 0.4%), and sepsis (n = 23, 0.4%). Predictors for readmission were prior ER visit (OR 1.96), multiple chronic conditions (OR 1.69), obesity (nonobese, OR 0.49), race (African American, OR 1.43), admission status (ER admission, OR 2.29), and elevated hemoglobin A1c (OR 1.80). The mean direct hospital cost for an ER visit was $1971, with 75% of visits costing less than $1890, and the average readmission cost was $7347, with 75% of readmissions costing less than $8820. Over the 5-year study period, the cost to the institution for 90-day return ER visits was $5.1 million.CONCLUSIONSRisk factors for 90-day ER visit and readmission after elective lumbar spine surgery include medical comorbidities and socioeconomic factors. Proper patient counseling, appropriate postoperative pain management, and optimization of modifiable risk factors prior to surgery are areas to focus future efforts to lower 90-day ER visits and readmissions and reduce healthcare costs.

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176 Efficiency of Spinal Anesthesia in Comparison to General Anesthesia in Lumbar Spine Surgery: A Retrospective Analysis of 544 Patients

Neurosurgery ◽

10.1093/neuros/nyx417.176 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 245-246

Author(s):

John Thomas Pierce ◽

Prateek Agarwal ◽

Paul J Marcotte ◽

William Charles Welch

Keyword(s):

Lumbar Spine ◽

Blood Loss ◽

Hospital Stay ◽

General Anesthesia ◽

Spinal Anesthesia ◽

Spine Surgery ◽

Operative Time ◽

Length Of Hospital Stay ◽

Lumbar Spine Surgery ◽

Anesthesia Time

Abstract INTRODUCTION Lumbar spine surgery can be successfully performed using various anesthetic techniques. Previous studies have shown varying results in selected outcomes when directly comparing spinal anesthesia (SA) to general anesthesia (GA) in lumbar surgery. We sought to elucidate the more expedient anesthetic technique. METHODS Following IRB approval, a retrospective review of patients undergoing elective lumbar decompression surgery using GA or SA was performed. Demographic data known to influence perioperative morbidity was collected as well as safety and efficiency parameters. After controlling for patient and procedure characteristics, simple linear and multivariate regression analyses were performed to identify differences in operative blood loss, operative time, time from entering the OR until incision, time from bandage placement to exiting the OR, total anesthesia time, time in the post-anesthesia care unit (PACU), and length of hospital stay. RESULTS >544 consecutive lumbar laminectomy and discectomy surgeries were identified with 183 undergoing GA and 361 undergoing SA. The following times were all shorter for patients receiving SA than GA: operative time (97.4 vs. 151.8 min., P < 0.001), total anesthesia time (145.6 vs. 217.5 min., P < 0.001), time from entering the OR until incision (38.3 vs. 46.8 min., respectively, P < 0.001), time from bandage placement until exiting the OR (10.2 vs. 17.2 min., P < 0.001), and length of hospital stay (1.5 vs. 3.1 days, P < 0.001). The mean PACU length of stay was longer in the SA group than the GA group (178.0 vs. 116.5 min., P < 0.001). Estimated blood loss was less in the SA group than the GA group (62.1 vs. 176.3 mL, P < 0.001). CONCLUSION Spinal anesthesia may be the more expedient method of anesthesia in lumbar spinal surgery for all perioperative time points except for time in the PACU.

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INFLUENCE OF ANESTHESIA TYPE ON INTRAOCULAR PRESSURE DURING SPINE SURGERY IN PRONE POSITION

Wiadomości Lekarskie ◽

10.36740/wlek202001120 ◽

2020 ◽

Vol 73 (1) ◽

pp. 104-106

Author(s):

Mykola V. Lyzohub ◽

Marine A. Georgiyants ◽

Kseniia I. Lyzohub ◽

Juliia V. Volkova ◽

Dmytro V. Dmytriiev ◽

...

Keyword(s):

Intraocular Pressure ◽

Lumbar Spine ◽

Spinal Anesthesia ◽

Spine Surgery ◽

Head Rotation ◽

Lumbar Spine Surgery ◽

Intravenous Anesthesia ◽

Group I ◽

Before And After ◽

Spinal Segments

The aim was to examine intraocular pressure (IOP) during lumbar spine surgery in PP under general vs spinal anesthesia and to compare it with volunteers in PP. Materials and methods: We performed randomized prospective single institutional trial. Patients were operated in PP with fixation of 1-2 spinal segments. Patients of group I (n = 30) were operated under SA, group 2A (n = 25) – under TIVA (total intravenous anesthesia) with 45° head rotation (left eye was located lower, than right eye), group 2B (n=25) – under TIVA with no head rotation (both eyes were located on the same level). IOP was measured with Maklakov method before and after surgery. Volunteers (n = 20) were examined before and 90 minutes after lying in PP with 45° head rotation. Results: In all patients and volunteers after lying in PP, we found that IOP have increased. In SA patients and in TIVA patients with no head rotation there was no difference between eyes. The most significant raise of IOP was found in the dependent eye of IIA group patients: it was higher than in volunteers and I group patients (p < 0.01), and IIB group patients (p < 0.05). In SA patients there was no difference in IOP comparing to volunteers. Conclusions: IOP increased in PP in healthy people and patients under anesthesia (SA and TIVA). IOP in SA patients did not differ from volunteers. IOP increased superiorly in the dependent eye in TIVA patients.

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What Is the Learning Curve for Lumbar Spine Surgery Under Spinal Anesthesia?

World Neurosurgery ◽

10.1016/j.wneu.2021.10.172 ◽

2021 ◽

Author(s):

James L. West ◽

Gaetano De Biase ◽

Mohamad Bydon ◽

Elird Bojaxhi ◽

Marvesh Mendhi ◽

...

Keyword(s):

Lumbar Spine ◽

Learning Curve ◽

Spinal Anesthesia ◽

Spine Surgery ◽

Lumbar Spine Surgery

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Spinal anesthesia for lumbar spine surgery in prone position: plain vs heavy bupivacaine

European Journal of Anaesthesiology ◽

10.1097/00003643-201406001-00373 ◽

2014 ◽

Vol 31 ◽

pp. 133 ◽

Cited By ~ 1

Author(s):

M. Lyzogub

Keyword(s):

Lumbar Spine ◽

Spinal Anesthesia ◽

Prone Position ◽

Spine Surgery ◽

Lumbar Spine Surgery

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Comparison of apixaban and rivaroxaban for anticoagulant effect after lumbar spine surgery: a single-center report

Future Science OA ◽

10.4155/fsoa-2017-0123 ◽

2018 ◽

Vol 4 (5) ◽

pp. FSO297 ◽

Cited By ~ 2

Author(s):

Kun Zhang ◽

Shenghao Zhao ◽

Wusheng Kan ◽

Jun Xiao ◽

Feifei Pu ◽

...

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Anticoagulant Effect ◽

Lumbar Spine Surgery ◽

Single Center ◽

Center Report

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EVALUATION OF PAIN SYNDROME AND EFFICIENCY OF PAIN MANAGEMENT IN LUMBAR SPINE SURGERY

EUREKA Health Sciences ◽

10.21303/2504-5679.2019.001068 ◽

2019 ◽

Vol 6 ◽

pp. 29-34

Author(s):

Mykola Lyzohub ◽

Marine Georgiyants ◽

Kseniia Lyzohub

Keyword(s):

Neuropathic Pain ◽

Lumbar Spine ◽

Pain Management ◽

Spinal Anesthesia ◽

Spine Surgery ◽

Multimodal Analgesia ◽

Opioid Consumption ◽

Total Intravenous Anesthesia ◽

Lumbar Spine Surgery ◽

Intravenous Anesthesia

Multimodal analgesia for lumbar spine surgery is still a controversial problem, because of possible fusion problems, significant neuropathic component of pain, and influence of anesthesia type. Aim of the study was to assess the efficacy of pain management after lumbar spine surgery considering characteristics of pain, type of anesthesia and analgesic regimen. Material and methods. 254 ASA I-II patients with degenerative lumbar spine disease were enrolled into prospective study. Patients were operated either under spinal anesthesia (SA) or total intravenous anesthesia (TIVA). In postoperative period patients got either standard pain management (SPM – paracetamol±morphine) or multimodal analgesia (MMA – paracetamol+parecoxib+pregabalin±morphine). Results. We revealed neuropathic pain in 53.9 % of patients, who were elected for lumbar spine surgery. VAS pain score in patients with neuropathic pain was higher, than in patients with nociceptive pain. Total intravenous anesthesia was associated with greater opioid consumption during the first postoperative day. Multimodal analgesia based on paracetamol, parecoxib and pregabalin allowed to decrease requirements for opioids, postoperative nausea and dizziness. Pregabalin used for evening premedication had equipotential anxiolytic effect as phenazepam without postoperative cognitive disturbances. Conclusions. Multimodal analgesia is opioid-sparing technique that allows to decrease complications. Spinal anesthesia is associated to a decreased opioid consumption in the 1st postoperative day.

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