DOI: https://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20222702
Published: 2022-10-27

Awake spinal fusion: a retrospective analysis of minimal invasive single level transforaminal lumbar interbody fusion done under spinal anaesthesia in 150 cases

Ameya Rangnekar, Mani K. Anand, Praveen Goparaju, Amit Chugh, Abhijith Shetty, Saijyot Raut, Vishal Kundnani

Abstract


Background: Spinal anaesthesia carries the advantage of having rapid onset, lesser blood loss, early recovery and hospital stay as compared to general anaesthesia. The present study evaluated outcomes of awake spinal fusion i.e., minimal invasive single level transforaminal lumbar interbody fusion (MIS-TLIF) under spinal anaesthesia. Current study is a retrospective analysis of prospectively collected data carried to assess patient related outcome benefits for a single level transforaminal lumbar interbody fusion done under spinal anaesthesia.

Methods: Patients who fit deemed criteria not responding to 6 weeks of conservative treatment to lumbar degenerative pathologies underwent MIS-TLIF. The demographic data, visual analogue pain scale (VAS), Oswestry disability index (ODI), blood loss, time from entering operation theatre to time of incision, time of bandaging to exit from operation theatre, time of stay in post anaesthesia care unit (PACU), duration of surgery, nausea/vomiting, urinary retention, requirement of analgesics, duration of stay in hospital, peri-operative complications, fusion rate and satisfaction score were compiled and assessed.

Results: 150 patients were operated with MISTLIF under spinal anaesthesia. VAS and ODI score improved significantly at final follow up (p<0.05). The mean duration of surgery was 148±18.24 minutes and blood loss were 109.64±110.45 ml. The average time from entering OT to incision and bandaging to exit was respectively 27.32±8.44 and 6.43±3.28 minutes. Mean PACU time was 36.74±6.32 minutes while duration of stay averaged 1.58±0.67 days. Post operative analgesia requirement was in 10.6% patients and radiographic fusion was observed in 96.6% patients. 90.6% patients were fully satisfied with spinal anaesthesia.

Conclusions: Awake spinal fusion should be considered as a novel surgical approach with newer minimal invasive surgical techniques and regional anaesthesia to improve patient satisfaction and overall surgical outcome.


Keywords


Spinal anaesthesia, Spinal fusion, TLIF, ODI, VAS, MIS TLIF

Full Text:

PDF

References


Rajaee SS, Bae HW, Linda EA, Delamarter RB. Spinal fusion in the United States. Spine. 2012;37(1):67-76.

Cloward RB. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. J Neurosurg. 1953;10:154-68.

Harms J, Rolinger H. A one-stager procedure in operative treatment of spondylolisthesis: dorsal traction-reposition and anterior fusion. Orthop Ihre Grenzgeb. 1982;120:343-7.

Harms J, Jeszenszky D. The unilateral transforaminal approach for posterior lumbar interbody fusion. Orthop Traumatol. 1998;6:88-99.

Foley KT, Holly LT, Schwender JD. Minimally invasive lumbar fusion. Spine (Phila Pa 1976). 2003;15:S26-35.

Demirel CB, Kalayci M, Ozkocak I, Altunkaya H, Ozer Y, Acikgoz B. A prospective randomized study comparing perioperative outcome variables after epidural or general anesthesia for lumbar disc surgery. J Neurosurg Anesthesiol. 2003;15:185-92.

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.

Pflug AE, Halter JB. Effect of spinal anesthesia on adrenergic tone and the neuroendocrine responses to surgical stress in humans. Anesthesiology. 1981;55:120-6.

McLain RF, Tetzlaff JE, Bell GR, Uwe-Lewandrowski K, Yoon HJ, Rana M. Microdiscectomy: spinal anesthesia offers optimal results in general patient population. J Surg Orthop Adv. 2007;16:5-11.

Rodgers A, Walker N, Schug S. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321:1493.

McLain RF, Bell GR, Kalfas I, Tetzlaff JE, Yoon HJ. Complications associated with lumbar laminectomy: a comparison of spinal versus general anesthesia. Spine. (Phila Pa 1976) 2004;29:2542-7.

Chen HT, Tsai CH, Chao SC. Endoscopic discectomy of L5-S1 disc herniation via an interlaminar approach: prospective controlled study under local and general anesthesia. Surgical Neurol Int. 2011;2:93.

Greenbarg PE, Brown MD, Pallares VS, Tompkins JS, Mann NH. Epidural anesthesia for lumbar spine surgery. J Spinal Disord. 1988;1:139-43.

Garg B, Ahuja K, Sharan AD. Awake spinal fusion. J Clin Orthop Trauma. 2020;11(5):749-752.

Bridwell KH, Lenke LG, McEnery KW, Baldus C, Blanke K. Anterior fresh frozen structural allografts in the thoracic and lumbar spine: do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine. 1995;20:1410-8.

Ahmad AS, Abdullah TS, Alhasan AH, Sugati FT, Namnqani RM, Safaa M. Al-Hasani. Satisfaction outcomesafter spinal anesthesia for caesarean section in Kauh in Jeddah and in MCH in Makkah. Int J Adv Res. 2008;2:1292-8.

Kai-Hong Chan A, Choy W, Miller CA, Robinson LC, Mummaneni PV. A novel technique for awake, minimally invasive transforaminal lumbar interbody fusion: technical note. Neurosurg Focus. 2019;46(4):E16.

Jhala A, Singh D, Mistry M. Minimally invasive transforaminal lumbar interbody fusion: Results of 23 consecutive cases. Indian J Orthop. 2014;48(6):562-7.

Wang MY, Grossman J. Endoscopic minimally invasive transforaminal interbody fusion without general anesthesia: initial clinical experience with 1-year follow-up. Neurosurg Focus 2016;40(2):E13.

Patel J, Kundnani V, Raut S, Meena M, Ruparel S. Perioperative complications of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF): 10 years of experience with MI-TLIF. Global Spine J. 2021;11(5):733-9.

Wang A, Yu Z. Surgical outcomes of minimally invasive transforaminal lumbar interbody fusion for highly migrated lumbar disc herniation. J Pain Res. 2021;14:1587-92.

Habib A, Smith ZA, Lawton CD, Fessler RG. Minimally invasive transforaminal lumbar interbody fusion: a perspective on current evidence and clinical knowledge. Minim Invasive Surg. 2012;2012:657342

Schwender JD, Holly LT, Rouben DP, Foley KT. Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech. 2005;18:S1-6.

Pierce JT, Kositratna G, Attiah MA, Kallan MJ, Koenigsberg R, Syre P, et al. Efficiency of spinal anesthesia versus general anesthesia for lumbar spinal surgery: a retrospective analysis of 544 patients. Local Reg Anesth. 2017;10:91-8.

Jellish WS, Shea JF. Spinal anaesthesia for spinal surgery. Best Pract Res Clin Anaesthesiol. 2003;17(3):323-34.

Lin P-C, Lin M-L, Huang L-C, Hsu H-C, Lin C-C. Music therapy for patientsreceiving spine surgery. J Clin Nurs. 2011;20(7-8):960-8.