Jeffrey R. Carlson, MD, MBA, CPE, FAOOS & Mark W. McFarland, DO
If you are considering spine surgery in the future, you will have many questions regarding your procedure, the type of anesthesia you will be given, and how safe your surgery will be from start to finish. In this Q & A, our expert spine specialists, Drs. Carlson and McFarland will address the latest type of spine surgery, called AWAKE (which really refers to the use of anesthesia during the spine procedure) and the benefits and risks. At OSC, our focus is entirely on patient safety and great outcomes for you. Let’s get started…
Q: What is AWAKE spine surgery?
A: Dr. Jeffrey Carlson: This type of spine surgery is being advanced by two spine surgeons out of Louisianna and the big difference is in the type and amount of anesthesia used during the spine procedure. When I say type – instead of general anesthesia – where the patient is fully sedated, immobilized and intubated (a machine breathes for them during surgery), the patient is given MAC anesthesia/twilight sedation (they don’t remember anything, and pain is managed) as well as local numbing medication injections. Some AWAKE procedures are only using local anesthetics.
Q: What are the benefits of AWAKE spine surgery? Isn’t less anesthesia better for the patient?
A: Dr. Mark McFarland: Every surgeon and anesthesiologist will tell you that anesthesia is hard on the body and the more anesthetics, paralytics and opiates used during surgery, the longer it takes for the body to process them, which can add to the recovery time of the patient.
Any operation that subjects the patient to less anesthesia will provide benefits to the patient – that is a given. Here are just a few to consider:
- Reduced side effects: Patients who undergo AWAKE surgery often have fewer side effects like nausea, vomiting, and fatigue. They don’t suffer a sore throat from being intubated. They may also experience less bruising and swelling and require fewer narcotic pain medications after surgery.
- Faster recovery: Patients who undergo local anesthesia may recover faster because fewer drugs have been administered.
- Cost savings: Low-flow anesthesia can decrease the overall cost of anesthetics and the anesthesiologist
However, there are also concurrent intra-operative risks that must be considered by the spine surgeon and weighed heavily. Patient safety, not convenience, must always be my priority.
At OSC, Dr. Jeffrey Carlson and I pioneered outpatient spine surgery many years ago, using minimal anesthesia, while keeping our patient immobilized and safe. We send our patients home the same day (usually within three hours of surgery) to recover with in-home nursing and PT care. We have had incredible success with our spine program and our patients have the outcomes to prove what we say is true!
Q: What are the risks to AWAKE spine surgery? Why is patient safety such a concern?
A: Dr. Carlson: I think it is important to highlight the safety reasons why I prefer my patients to be fully sedated and immobile during spine surgery.
- I’m working directly around the spinal cord and spinal nerves, which control the function of most of the body from the neck down. If a patient is not completely immobilized during surgery and moves while I’m in the process of cutting with a scalpel, drilling a hole in a vertebra or sawing a lamina, the consequences could be catastrophic.
- Things go wrong on the operating table – it’s a fact of life. Heart attacks, strokes, pulmonary embolisms, etc. can happen in the blink of an eye to even the healthiest patient. Patients who need life saving measures need them immediately. Stopping a spine surgery, with the patient’s incision wide open and their spinal structures exposed and unstable, to try and flip them over and establish an emergency airway to administer life-support, is not my idea of putting my patient’s safety first. Period.
Q: Can anyone get AWAKE spine surgery? Are there special qualifications?
A: Dr. McFarland: No, not just anyone can have this surgery and there are some qualifiers, which are:
- Patients must be very healthy and cleared by physicians
- Only certain spine procedures can be performed as AWAKE procedures
- A limited number of spine surgeons do these procedures
Q: If your patient asked you if you would recommend AWAKE spine surgery to a family member, what would you say?
A: Dr. McFarland: Dr. Jeffrey Carlson and I agree – while it sounds like a good idea, I think it is mostly marketing hype and not in the best interest of most patients. However, do your own research, learn everything you can and consult the experts.