Awake minimally invasive transforaminal lumbar interbody fusion with a pedicle-based retraction system

Biase, Gaetano De; Bechtle, Perry S.; Leone, Bruce J.; Quiñones‐Hinojosa, Alfredo; Abode-Iyamah, Kingsley

doi:10.1016/j.clineuro.2020.106313

Cited by 17 publications

(21 citation statements)

References 19 publications

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“…In our series, we used a direct decompression technique performed through a pedicle-based retraction system, as previously reported. 12 Despite the retrospective nature of the study, we minimized confounding variables by analyzing cases from a single surgeon at a single institution and managed by the same anesthesia staff. Furthermore, to minimize selection bias, the GA control group was selected from the few months prior to our institution starting an SA protocol for spine surgery; therefore, those patients received GA independently from whether or not they were deemed ideal candidates for SA.…”

Section: Discussionmentioning

confidence: 99%

“…The same surgical technique was used for all patients. Our group has previously described the technique we use to perform MIS-TLIF with SA using a pedicle-based retractor system, 12 which is the same technique used for patients who received GA in this study. The groups were checked for clinical factors including comorbidities (obesity, hypertension, diabetes, and obstructive sleep apnea), age, and American Society of Anesthesiologists (ASA) class, to verify that they were homogeneous.…”

Section: Methods Study Design and Patient Populationmentioning

confidence: 99%

“…laminectomy and discectomy, especially within Enhanced Recovery After Surgery (ERAS) protocols. [8][9][10][11][12] Both general anesthesia (GA) and SA have been adopted for surgical treatment of lumbar spine disorders, but GA is used far more widely, and exclusively, in many settings. Regional anesthesia is frequently used in orthopedic surgery and as part of ERAS protocols in other specialties.…”

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confidence: 99%

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Spinal versus general anesthesia for minimally invasive transforaminal lumbar interbody fusion: implications on operating room time, pain, and ambulation

Biase

Gruenbaum

West

et al. 2021

Neurosurgical Focus

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OBJECTIVE There has been increasing interest in the use of spinal anesthesia (SA) for spine surgery, especially within Enhanced Recovery After Surgery (ERAS) protocols. Despite the wide adoption of SA by the orthopedic practices, it has not gained wide acceptance in lumbar spine surgery. Studies investigating SA versus general anesthesia (GA) in lumbar laminectomy and discectomy have found that SA reduces perioperative costs and leads to a reduction in analgesic use, as well as to shorter anesthesia and surgery time. The aim of this retrospective, case-control study was to compare the perioperative outcomes of patients who underwent minimally invasive surgery (MIS)–transforaminal lumbar interbody fusion (TLIF) after administration of SA with those who underwent MIS-TLIF under GA. METHODS Overall, 40 consecutive patients who underwent MIS-TLIF by a single surgeon were analyzed; 20 patients received SA and 20 patients received GA. Procedure time, intraoperative adverse events, postoperative adverse events, postoperative length of stay, 3-hour postanesthesia care unit (PACU) numeric rating scale (NRS) pain score, opioid medication, and time to first ambulation were collected for each patient. RESULTS The two groups were homogeneous for clinical characteristics. A decrease in total operating room (OR) time was found for patients who underwent MIS-TLIF after administration of SA, with a mean OR time of 156.5 ± 18.9 minutes versus 213.6 ± 47.4 minutes for patients who underwent MIS-TLIF under GA (p < 0.0001), a reduction of 27%. A decrease in total procedure time was also observed for SA versus GA (122 ± 16.7 minutes vs 175.2 ± 10 minutes; p < 0.0001). No significant differences were found in intraoperative and postoperative adverse events. There was a difference in the mean maximum NRS pain score during the first 3 hours in the PACU as patients who received SA reported a lower pain score compared with those who received GA (4.8 ± 3.5 vs 7.3 ± 2.7; p = 0.018). No significant difference was observed in morphine equivalents received by the two groups. A difference was also observed in the mean overall NRS pain score, with 2.4 ± 2.1 for the SA group versus 4.9 ± 2.3 for the GA group (p = 0.001). Patients who received SA had a shorter time to first ambulation compared with those who received GA (385.8 ± 353.8 minutes vs 855.9 ± 337.4 minutes; p < 0.0001). CONCLUSIONS The results of this study have pointed to some important observations in this patient population. SA offers unique advantages in comparison with GA for performing MIS-TLIF, including reduced OR time and postoperative pain, and faster postoperative mobilization.

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Section: Discussionmentioning

confidence: 99%

Section: Methods Study Design and Patient Populationmentioning

confidence: 99%

mentioning

confidence: 99%

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Spinal versus general anesthesia for minimally invasive transforaminal lumbar interbody fusion: implications on operating room time, pain, and ambulation

Biase

Gruenbaum

West

et al. 2021

Neurosurgical Focus

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“…Awake MIS spinal fusion protocols are an emerging alternative to traditional spinal surgeries performed un-der general anesthesia or with open techniques. 6 While many have hypothesized that awake MIS techniques may offer benefits to patients such as decreased postanesthesia recovery periods and reduced LOS, this has not yet been thoroughly evaluated in the literature. 10 In the current study, we have reported our institutional experience with performing awake MIS-TLIF and also presented a national analysis of recent TLIF cases from the NSQIP registry comparing those performed awake versus those performed under general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…5 Recent literature has demonstrated positive outcomes for patients undergoing MIS-TLIF, including minimized operative time, reduced postoperative analgesic use, decreased hospital length of stay (LOS), and less overall soft-tissue damage. 6 Patients undergoing MIS-TLIF are typically intubated and administered general anesthesia; however, the perioperative adverse effects of general anesthesia such as memory loss, nausea, and transient impairment of sensory and motor functions have caused concerns for patients and physicians. 7 To address these limitations, several sur-…”

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confidence: 99%

Single-level awake transforaminal lumbar interbody fusion: a Mayo Clinic institutional experience and national analysis

Abode-Iyamah

Ghaith

Bhandarkar

et al. 2021

Neurosurgical Focus

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OBJECTIVE Awake transforaminal lumbar interbody fusion (TLIF) is a novel technique for performing spinal fusions in patients under conscious sedation. Whether awake TLIF can reduce operative times and decrease the hospital length of stay (LOS) remains to be shown. In this study, the authors sought to assess the differences in clinical outcomes between patients who underwent awake TLIF and those who underwent TLIF under general anesthesia by using institutional experience at the Mayo Clinic and the National Surgical Quality Improvement Program (NSQIP) database. METHODS Chart review was performed for a consecutive series of patients who underwent single-level minimally invasive surgery (MIS)–TLIF performed by a single surgeon (K.A.I.) at a single institution. Additionally, the NSQIP database was queried from 2016 to 2019 for patients who underwent awake TLIF as well as propensity score–matched patients who underwent TLIF under general anesthesia. RESULTS A total of 20 patients at Mayo Clinic underwent awake single-level MIS-TLIF. The mean operative time was 122 ± 16.68 minutes, and the mean estimated blood loss was 39 ± 30.24 ml. No intraoperative complications were reported. A total of 96 patients who underwent TLIF (24 awake and 72 under general anesthesia) were analyzed from the NSQIP database. The mean LOS was less in the awake cohort (1.4 ± 1.381 days) than the general anesthesia cohort (3 ± 2.274 days) (p = 0.002). CONCLUSIONS Evidence from the authors’ institutional experience and national analysis has demonstrated that awake MIS-TLIF is efficient and can reduce hospital LOS.

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How to start an awake spine program: Protocol and illustrative cases

Waguia

Touko

Sykes

et al. 2022

IBRO Neuroscience Reports

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Awake minimally invasive transforaminal lumbar interbody fusion with a pedicle-based retraction system

Cited by 17 publications

References 19 publications

Spinal versus general anesthesia for minimally invasive transforaminal lumbar interbody fusion: implications on operating room time, pain, and ambulation

Spinal versus general anesthesia for minimally invasive transforaminal lumbar interbody fusion: implications on operating room time, pain, and ambulation

Single-level awake transforaminal lumbar interbody fusion: a Mayo Clinic institutional experience and national analysis

How to start an awake spine program: Protocol and illustrative cases

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