‘Awake’ Spine Surgery: Today’s Minimally Invasive Option for Patients
Awake Spinal Fusion is a minimally invasive procedure that doesn’t require general anesthesia. Instead of a lengthy hospital stay, you’re up and about in just a few hours.
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‘Awake’ Spine Surgery: Today’s Minimally Invasive Option for Patients

By Dr. Alok Sharan
Jul. 12, 2022

New discoveries, technologies, and techniques are aiding spine surgeons in successfully completing surgeries on patients who are awake through the entire procedure. In fact, these “awake” spinal fusions generally take only two to two hours, with up and walking before the end of the day — with minimal or no pain.

Faster recovery times and shorter hospital stays aren’t the only advantages of choosing this option over traditional spine surgery. In contrast to anesthesia and less post-operative narcotics that induce a dazed, disorientated, and unbalanced state, patients return to normal life much faster. Since you won’t be undergoing general anesthesia, you decrease the chance of developing postoperative nausea and delirium after surgery.

Awake Spinal Surgery Versus Traditional Spine Surgery

To envision the benefits first, you need to envision the potential complications of going through a traditional spine surgery under general anesthesia. Traditional spinal fusion surgery takes approximately three to four hours to complete under general anesthesia, and a patient is required to stay in the hospital for two to three days. Patients also receive pain medication intravenously (IV).

The risks and side effects of general anesthesia can make it unappealing. It induces a sleep-like state and can include side effects. These can include memory loss, nausea, and delirium. Additionally, the cognitive function of older individuals may be affected. General anesthesia usually takes 24 hours to completely leave your system, so it’s usually necessary for patients to stay in the hospital.  Sometimes the effects of general anesthesia can linger for longer.

That’s where minimally invasive disk surgery is making major inroads. An important component of this new approach is the advent of a long-acting local anesthetic approved by the U.S. Food and Drug Administration (FDA). With the advancement of regional and local anesthetics, it’s now possible for surgeons to perform awake surgery, which is already commonly used for brain surgery and other surgeries without general anesthesia. Hence, the procedure does not cause you pain, yet you remain conscious and alert.

How it Works & What to Expect

Before your surgeon makes the incision, an anesthetic is injected into a muscle in the low back which relieves pain for 48-72 hours. Awake spine surgery usually takes half the time, and patients are out of the hospital within 4 hours. Although some patients continue taking pain medication after the long-acting local anesthetic wears off, the pain management is much more tolerable.

As a result, overnight stays at some hospitals have been reduced by up to 65 percent because these patients are not receiving intravenous narcotics after the surgery, according to the University of California San Francisco’s Spine Center (UCSF Spine Center).

The Mayo Clinic also recently documented the specific advantages of local spinal anesthesia that surgeons are increasingly using. They include: “A 27 percent reduction in total operating room time, lower overall pain scores in the first three hours after surgery, ambulation (on average) of 7.8 hours earlier than ambulation after general anesthesia, and shorter hospital stays.”

These outpatient spinal surgery procedures are performed with patients lying flat on their stomachs. In fact, many patients will wear headphones and listen to their favorite music during surgery. A patient is usually comfortably situated with the surgeon right there, both conveniently communicating with each other the entire time. You can talk to the surgeon at any point — and vice versa — to make sure you are comfortable.

The Wave of the Future?

Back-pain sufferers are increasingly educating themselves about this latest technique in outpatient spinal fusions, which is leading to more proactive decisions and successful outcomes. In today’s medical world, professionals are open to adopting newer technologies and innovations.

“Awake spine fusion surgery is most beneficial for patients who are at risk for adverse reaction or long recovery from general anesthesia,” states a Duke University School of Medicine article, describing the first procedure at the school in November 2019. “It seemed to be just the right time for a novel approach — not only for patients who can’t tolerate general anesthesia but for a much larger segment of the patient population. The benefits of the surgery without general anesthesia include a quicker recovery and less time in the hospital.”

As a result, this latest technique benefits doctor-patient relationships and increases patient confidence. Identifying warning signs and compliance prior to surgery, it’s a win-win situation for all involved.

What’s more interesting is, when performed with awake spinal surgery, endoscopic spine surgery (using an endoscope to examine and work on the interior of the body from the outside) has proven to be a big success. Physicians are checking for unusual pain patterns during endoscopic surgery on patients under regional anesthesia, finding very minimal patterns or none whatsoever. They have discovered that more spinal conditions are being treated through the endoscopic-awake surgery combination than ever before.

Awake spine surgery isn’t a fad; it’s a new tool with positive impacts on any patient’s life. Patients can undergo awake surgery with faster recovery and shorter hospital stay as long as they are compliant and relatively healthy. All they have to do is prepare for what the surgery will look and feel like, and then relax. By utilizing the least invasive means possible, this type of procedure attracts patients who wish to heal very quickly.

Reimagining Spine Surgery from Beginning to End

Awake Spinal Fusion allows patients to awaken sooner with significantly fewer side effects. In most cases, patients have recovered sufficiently to ambulate a few hours after surgery. Dr. Alok Sharan and his staff invite you to experience spine surgery reimagined from beginning to end.

You’ll not only receive the most advanced procedure available but a caring, compassionate, patient-centric attitude. You’ll experience a quicker overall recovery, less nausea during the recovery period, better pain control, earlier recovery of bowel function, easier breathing resulting from better pain control, and easier participation in physical therapy.