Posterior lumbar stabilization surgery under spinal anaesthesia for patients with degenerative spondylolisthesis, spinal stenosis and lumbar compression fracture

Abstract

AIm:Spinal anesthesia is an appropriate technique for lumbar spine surgeries of two to three hours duration. The aim of this study is to document our experience on spinal anesthesia administered to the patients with degenerative lumbar spine. mAterIAl and methOds: A total of 497 patients underwent spinal stabilization surgery with spinal anesthesia for degenerative lumbar spinal disorders in an 8-year period. Spinal anesthesia was performed at the L3-L4 or L4-L5 level and subarachnoid block was achieved with 15 mg of 0.5% plain bupivacaine with 2 µg of fentanyl and 0.2 mg of epinephrine. There was no failure of anesthesia. The patients were closely monitored for complications associated with the SA technique and especially hypotension and bradycardia but no gross alterations in cardiovascular stability were noted. results: Among the 497 patients, 139 were male and 358 were female with a median age of 51 years. The average anesthesia duration was 130 minutes and the average operative time was 85 minutes. In the postoperative period 36 patients has nausea (7.2%) and 18 of them had vomiting (3.6%) that required one dose of antiemetic. No spinal headache was observed and 36 (7.2%) patients complained of urinary retention. All recovered with urinary cannulation within 24 hours. No respiratory complication occurred and no patient died.COnClusIOn: Spinal anesthesia is a safe and effective procedure for the lumbar spinal stabilization surgery, especially in high-riskpatients. Proper precautions should be taken in order to achieve an effective anesthesia for these operations. BulGulAr: Toplam 497 hastanın 139 tanesi erkek, 358 tanesi ise bayandı ve ortalama yaş 51 idi. Ortalama anestezi süresi 130 dakika ve ortalama ameliyat süresi ise 85 dakika olarak hesaplandı. Postoperatif dönemde 36 (%7,2) hastada bulantı oldu ve bunların 18 (%3,6) tanesinde kusma görüldü. Bir doz antiemetik ile düzeldi. Spinal anesteziye bağlı başağrısı hiçbir hastada görülmedi ancak 36 (%7,2) hastada üriner retansiyon görüldü ve bu da 24 saat içinde üriner kanülasyon ile düzeldi. Solunum sıkıntısı görülmedi ve hiçbir hasta ölmedi. sOnuÇ: Spinal anestezi özellikle yüksek riskli hasta grubunda lomber stabilizasyon cerrahisi için güvenli ve etkili bir yöntemdir. Bu tür ameliyatlarda etkin anestezinin sağlanması için uygun tedbirlerin alınması gereklidir.

Spinal Anesthesia in Elderly Patients Undergoing Lumbar Spine Surgery

“…In 2015, concurrent with the present study, Erbas et al 9 reported the results of lumbar fusion surgery with spinal anesthesia in a case series of 497 patients in Turkey. Of these, 119 patients were between the ages of 71 and 84 years.…”

“…In the 3 previously published studies reporting the use of spinal anesthesia for lumbar fusion, the number of levels fused was unclear. [7][8][9] The literature has suggested that spinal anesthesia may offer intraoperative benefits compared with general anesthesia for 1-to 3-level lumbar decompressions. These benefits included decreased blood loss, 1,2 lower mean heart rate, 2,3,6 lower mean arterial pressure (MAP), 2,3,6 and decreased variability in both mean heart rate and mean MAP, 1,4 as well as postoperative benefits such as decreased dependence on narcotics, 1,2 and lower rates of both urinary retention 3,6 and nausea.…”

“…Mean operative time was 101 minutes (range, 30-210 minutes), and mean operative blood loss was 187 mL (range, 20-700 mL). Mean maximum inpatient postoperative visual analog scale score was 6.2 (range, [1][2][3][4][5][6][7][8][9][10]. Nausea occurred in 21% (12 of 56) of the patients.…”

“…Three published studies on spinal anesthesia have included patients 70 years or older, but unfortunately, no study to date has focused exclusively on the geriatric population. [7][8][9] The purpose of this study was to report a single institution's experience using spinal anesthesia for lumbar spine decompression procedures or combined decompression and fusion procedures in patients 70 years or older.…”

Complex Lumbar Spine Fusion for an Elderly Patient Under Spinal Anesthesia

“…Unfortunately, few studies report on the application of spinal anesthesia for patients older than 70 years undergoing spine surgery and for procedures lasting more than 2 hours. [1][2][3][4] The authors report the case of an elderly patient with severe spine degeneration who elected for surgery with spinal anesthesia. To the authors' knowledge, this is the most complex lumbar spine fusion performed under spinal anesthesia for a geriatric patient.…”