Complex Lumbar Spine Fusion for an Elderly Patient Under Spinal Anesthesia

Lessing, Noah L; Edwards, Charles C.; Lin, Charles; Brown, Charles H.

doi:10.3928/01477447-20170602-02

Cited by 10 publications

(7 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To date, such has not been necessary in our institution's experience of more than 200 patients with surgical durations up to 3 hours and 30 minutes. 22 The present study has several weaknesses. Given the study design, there may have been selection bias as reflected in demographic differences between groups, namely age, sex, and BMI.…”

Section: Discussionmentioning

confidence: 82%

Spinal Anesthesia for Geriatric Lumbar Spine Surgery: A Comparative Case Series

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background: The use of spinal anesthesia (SA) as opposed to general anesthesia (GA) during elective lumbar spine surgery is an emerging technique and represents a potentially modifiable factor to limit perioperative complications. Few studies, however, have compared these anesthetic techniques in an elderly population. The aim of this study is to determine if SA is a safe alternative to GA for lumbar spine surgery in elderly patients. Methods: A retrospective, consecutive case series study was performed. All patients aged 70 years and older who underwent lumbar spine decompression or combined decompression and fusion using either SA or GA during a 2-year period at a single institution were identified. Demographics and perioperative outcomes were compared. Results: Of all patients meeting the inclusion criteria, 56 patients (19%) received SA and 239 (81%) received GA. Patients receiving SA were slightly older (median age, 77 years versus 75 years, P ¼ .002), consisted of more men (57% versus 36%, P ¼ .01), and had a lower mean body mass index (28.3 versus 30.1, P ¼ .03). Indications for surgery and type of surgery were similar between groups. On average, operative times with SA were 101 minutes versus 103 minutes with GA (P ¼ .71). After controlling for age, sex, and body mass index, patients receiving SA had decreased estimated blood loss (b ¼ À75 mL; 95% confidence interval [CI], À140.6, À9.4; P ¼ .025) and intraoperative intravenous fluid requirements (b ¼À205 mL; 95% CI, À389.4, À21.0; P ¼ .029), shorter postanesthesia care unit stays (b ¼À41 minutes; 95% CI, À64.6, À16.9; P ¼ .001), lower maximum visual analog scale pain scores (b ¼À0.89 points; 95% CI, À1.6, À0.1; P ¼ .020), and decreased odds of receiving blood transfusion (odds ratio, 0.12; 95% CI, 0.01, 0.62; P ¼ .45); there were no significant differences in operative time, length of stay, nausea, or oral morphine equivalents consumed per day. Complication rates were similar between groups. Conclusion: Spinal anesthesia is a reasonable, safe alternative to general anesthesia for lumbar spine surgery in elderly patients with degenerative conditions. Lumbar Spine PATIENTS AND METHODS With Institutional Review Board approval, we retrospectively identified a consecutive series of patients from a prospectively collected database

show abstract

Section: Discussionmentioning

confidence: 82%

Spinal Anesthesia for Geriatric Lumbar Spine Surgery: A Comparative Case Series

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Several studies evaluating SA versus GA in lumbar laminectomy and discectomy have found that SA reduced perioperative costs by reducing drug consumption and led to a reduction in analgesic use, shorter anesthesia and surgery time, reduced blood loss, and less postoperative nausea and vomiting. 9,10,[14][15][16][17][18][19] To the best of our knowledge, no studies have looked at the perioperative outcomes and potential benefits of SA versus GA in MIS-TLIF.…”

mentioning

confidence: 99%

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

View full text Add to dashboard Cite

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.

show abstract

“…One study focusing primarily on the geriatric population reported the case of an extended spine surgery (210 min) with use of SA [8]. In a separate report, Lessing et al described a complex case of a 5-level posterior lumbar fusion using SA in a 72-year-old female lasting 214 min [10]. We present a 3-level lumbar fusion surgery in 73-year old high-risk patient (ASA III) performed under SA lasting 224 min.…”

Section: Discussionmentioning

confidence: 99%