Download PDF
J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/s-0043-1771267
Original Article

Efficacy and Advantages of Spinal Anesthesia in Lumbar Disk Surgery

Mehmet Yigit Akgun 
1   Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
,
Helin İlkay Orak
1   Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
,
Mehmet Huseyin Akgul
2   Department of Neurosurgery, Yuksek Ihtisas Hospital, Kirikkale, Turkey
,
Ozkan Ates
1   Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Background Quality of life (QoL) may be affected due to various reasons such as low back or leg pains with accompanying neurologic problems. Lumbar disk surgery is one of the most common performed surgeries to relieve those symptoms. Various anesthetic techniques can be used safely to perform lumbar disk surgeries. Properties that make an anesthetic technique good are mainly the quick onset and returning of the effects. This large retrospective study with patients who have undergone lumbar disk surgery under spinal anesthesia aims to evaluate the perioperative and postoperative parameters of the spinal anesthesia and review the literature.

Methods Cases operated under spinal anesthesia between January 2017 and December 2020 were investigated, and 617 patients who underwent simple lumbar disk surgery were included in the study. Demographic characteristics and American Society of Anesthesiologists (ASA) physical status of the patients were recorded. Visual analog scale (VAS) and QoLscores were obtained before and after the operation.

Results There were 282 (45.7%) male and 335 (54.3%) female patients with a mean age of 39.48 ± 16.71 years (range: 18–58 years) at symptom onset. The mean operating time was 46.3 minutes (range: 22–68 minutes). Average blood loss was 85 mL (range: 55–125 mL). All the patients were mobilized 6 to 12 hours after surgery. In our patient group, there were both high- and normal-risk groups in terms of the ASA physical status. During the clinical follow-up, a statistically significant improvement was found for the VAS and QoL scores (p < 0.05).

Conclusions In this large retrospective study, our results have confirmed that spinal anesthesia is at least comparable to general anesthesia and even superior to it in some aspects.

Keywords

spinal anesthesia - lumbar - disk - surgery


Publication History

Received: 17 August 2022

Accepted: 30 May 2023

Article published online:
10 April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Cloyd JM, Acosta Jr FL, Ames CP. Complications and outcomes of lumbar spine surgery in elderly people: a review of the literature. J Am Geriatr Soc 2008; 56 (07) 1318-1327
    PubMedGoogle Scholar
  • 2 De Rojas JO, Syre P, Welch WC. Regional anesthesia versus general anesthesia for surgery on the lumbar spine: a review of the modern literature. Clin Neurol Neurosurg 2014; 119: 39-43
    CrossrefPubMedGoogle Scholar
  • 3 Ahmed Jonayed S, Alam MS, Al Mamun Choudhury A, Akter S, Chakraborty S. Efficacy, safety, and reliability of surgery on the lumbar spine under general versus spinal anesthesia: an analysis of 64 cases. J Clin Orthop Trauma 2021; 16: 176-181
    PubMedGoogle Scholar
  • 4 American Society of Anesthesiologists. ASA Standards GaS, October 2007 http://www2.asahg.org/publications/p-106-asa-standards.guidelines-and-statements.aspx
    PubMed
  • 5 Haefeli M, Elfering A. Pain assessment. Eur Spine J 2006; 15 (Suppl. 01) S17-S24
    CrossrefPubMedGoogle Scholar
  • 6 Ware JE, Kosinski M, Dewey JE. SF-36 Health Survey: Manual and Interpretation Guide. Johnston, RI: QualityMetric Inc.; 2000
    Google Scholar
  • 7 McLain RF, Bell GR, Kalfas I, Tetzlaff JE, Yoon HJ. Complications associated with lumbar laminectomy: a comparison of spinal versus general anesthesia. Spine 2004; 29 (22) 2542-2547
    PubMedGoogle Scholar
  • 8 McSwain JR, Doty JW, Wilson SH. Regional anesthesia in patients with pre-existing neurologic disease. Curr Opin Anaesthesiol 2014; 27 (05) 538-543
    PubMedGoogle Scholar
  • 9 Lee JK, Park JH, Hyun SJ, Hodel D, Hausmann ON. Regional anesthesia for lumbar spine surgery: can it be a standard in the future?. Neurospine 2021; 18 (04) 733-740
    PubMedGoogle Scholar
  • 10 Jellish WS, Thalji Z, Stevenson K, Shea J. A prospective randomized study comparing short- and intermediate-term perioperative outcome variables after spinal or general anesthesia for lumbar disk and laminectomy surgery. Anesth Analg 1996; 83 (03) 559-564
    PubMedGoogle Scholar
  • 11 Attari MA, Mirhosseini SA, Honarmand A, Safavi MR. Spinal anesthesia versus general anesthesia for elective lumbar spine surgery: a randomized clinical trial. J Res Med Sci 2011; 16 (04) 524-529
    PubMedGoogle Scholar
  • 12 Breton JM, Ludwig CG, Yang MJ. et al. Spinal anesthesia in contemporary and complex lumbar spine surgery: experience with 343 cases. J Neurosurg Spine 2021; 36 (04) 534-541
    PubMedGoogle Scholar
  • 13 De Biase G, Gruenbaum SE, West JL. et al. Spinal versus general anesthesia for minimally invasive transforaminal lumbar interbody fusion: implications on operating room time, pain, and ambulation. Neurosurg Focus 2021; 51 (06) E3
    CrossrefPubMedGoogle Scholar
  • 14 Finsterwald M, Muster M, Farshad M, Saporito A, Brada M, Aguirre JA. Spinal versus general anesthesia for lumbar spine surgery in high risk patients: Perioperative hemodynamic stability, complications and costs. J Clin Anesth 2018; 46: 3-7
    PubMedGoogle Scholar
  • 15 Pierce JT, Kositratna G, Attiah MA. et al. Efficiency of spinal anesthesia versus general anesthesia for lumbar spinal surgery: a retrospective analysis of 544 patients. Local Reg Anesth 2017; 10: 91-98
    PubMedGoogle Scholar
  • 16 Suzer MA, Kara U, Ozhan MO, Kamburoglu H, Eskin MB, Caparlar C. Spinal anesthesia versus general anesthesia in elderly patients undergoing lumbar instrumentation: a retrospective study. Turk Klin J Anest Reanim 2021; 19 (03) 105-113
    PubMedGoogle Scholar
  • 17 Sadrolsadat SH, Mahdavi AR, Moharari RS. et al. A prospective randomized trial comparing the technique of spinal and general anesthesia for lumbar disk surgery: a study of 100 cases. Surg Neurol 2009; 71 (01) 60-65 , discussion 65
    PubMedGoogle Scholar
  • 18 Meng T, Zhong Z, Meng L. Impact of spinal anaesthesia vs. general anaesthesia on peri-operative outcome in lumbar spine surgery: a systematic review and meta-analysis of randomised, controlled trials. Anaesthesia 2017; 72 (03) 391-401
    CrossrefPubMedGoogle Scholar
  • 19 Jabbari A, Alijanpour E, Mir M, Bani Hashem N, Rabiea SM, Rupani MA. Post spinal puncture headache, an old problem and new concepts: review of articles about predisposing factors. Caspian J Intern Med 2013; 4 (01) 595-602
    PubMedGoogle Scholar
  • 20 Eberhart LH, Morin AM, Kranke P, Geldner G, Wulf H. Transiente neurologische Symptome nach Spinalanästhesie. Eine quantitative systematische Ubersicht (Metaanalyse) randomisierter kontrollierter Studien. Anaesthesist 2002; 51 (07) 539-546
    PubMedGoogle Scholar
  • 21 Forget P, Borovac JA, Thackeray EM, Pace NL. Transient neurological symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics in adult surgical patients: a network meta-analysis. Cochrane Database Syst Rev 2019; 12 (12) CD003006
    CrossrefPubMedGoogle Scholar
  • 22 Capdevila X, Aveline C, Delaunay L. et al. Factors determining the choice of spinal versus general anesthesia in patients undergoing ambulatory surgery: results of a multicenter observational study. Adv Ther 2020; 37 (01) 527-540
    PubMedGoogle Scholar