Awake Spine Surgery: A Shift Towards Patient-Centered Care

Abstract

Spine surgeries are traditionally done under general anesthesia (GA) with endotracheal intubation; however, awake spine surgery is gaining momentum not only because it is more culturally accepted but because it is safer and also allows for rapid recovery, early mobilization and significantly reducing hospital stay, and ultimately cost of care. A patient who would ordinarily not agree to have surgery or those whom surgeons would not want to operate because of comorbid conditions are now benefiting from awake spine surgery. Awake spine surgery is pivoting on advance surgical techniques vis-à-vis advancement in regional anesthesia services. Cervical surgeries are now being done under deep or superficial cervical plexus block (CPB), while thoracic spine surgeries are done under thoracic epidural anesthesia, erector spinae plane block (ESPB), or thoracolumbar interfacial block. Lumbar spine surgeries are done under spinal anesthesia, epidural anesthesia, or even monitored anesthesia care depending on the invasiveness of the spine procedure. Surgeries either open or minimally invasive can be done successfully awake, with good patient outcome. The procedures under awake spine surgeries are explained in this book together with indication, contraindication, merit and demerit of this procedure. Despite all these aforementioned points, the awake spine surgery is found to be a viable and safe alternative to general anesthesia.