Awake spinal anesthesia facilitates spine surgery in poor surgical candidates: A case series.

dc.contributor.author

Sykes, David AW

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Tabarestani, Troy Q

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Salven, David S

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Chaudhry, Nauman S

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Wang, Timothy Y

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Gottfried, Oren N

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Shaffrey, Christopher I

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Guinn, Nicole R

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Gadsden, Jeffrey

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Ayoub, Chakib M

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Bullock, W Michael

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Berger, Miles

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Abd-El-Barr, Muhammad M

dc.date.accessioned

2023-06-15T14:20:38Z

dc.date.available

2023-06-15T14:20:38Z

dc.date.issued

2023-05

dc.date.updated

2023-06-15T14:20:37Z

dc.description.abstract

Background

Annually, hundreds of thousands of patients undergo surgery for degenerative spine disease (DSD). This represents only a fraction of patients that present for surgical consideration. Procedures are often avoided due to comorbidities that make patients poor candidates for general anesthesia (GA) and its associated risks. With increasing interest in awake surgery under spinal anesthesia (SA), the authors have observed that SA may facilitate spine surgery in patients with relative contraindications to GA. With this in mind, the authors set out to summarize the outcomes of a series of highly comorbid patients who received surgery under SA.

Methods

Case logs of a single surgeon were reviewed, and patients undergoing spine surgery under SA were identified. Within this group, patients were identified with relative contraindications to GA, such as advanced age and medical comorbidities. For these patients, for whom surgery was facilitated by SA, the medical records were consulted to report demographic information and patient outcomes.

Results

Ten highly comorbid patients were identified who received lumbar spine surgery for DSD under SA. Comorbidities included octogenarian status, obesity, and chronic health conditions such as heart disease. The cohort had a mean age of 75.5 and a mean American Society of Anesthesiologists Physical Status (ASA-PS) score of 3.1. The patients were predicted to have a 2.74-fold increase of serious complications compared to the average patient. There were no adverse events.

Conclusion

For patients with symptomatic, refractory DSD and relative contraindications to GA, SA may facilitate safe surgical intervention with excellent outcomes.
dc.identifier

S0028-3770(23)00041-3

dc.identifier.issn

0028-3770

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1773-0619

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https://hdl.handle.net/10161/27949

dc.language

eng

dc.publisher

Elsevier BV

dc.relation.ispartof

Neuro-Chirurgie

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10.1016/j.neuchi.2023.101444

dc.subject

Spine

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Lumbar Vertebrae

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Humans

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Brain Neoplasms

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Anesthesia, Spinal

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Anesthesia, General

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Wakefulness

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Aged

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Aged, 80 and over

dc.title

Awake spinal anesthesia facilitates spine surgery in poor surgical candidates: A case series.

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher I|0000-0001-9760-8386

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Guinn, Nicole R|0000-0001-6073-6317

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Gadsden, Jeffrey|0000-0003-3971-3879

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Ayoub, Chakib M|0000-0002-0496-0389

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Bullock, W Michael|0000-0002-8088-8390

duke.contributor.orcid

Berger, Miles|0000-0002-2386-5061

duke.contributor.orcid

Abd-El-Barr, Muhammad M|0000-0001-7151-2861

pubs.begin-page

101444

pubs.issue

3

pubs.organisational-group

Duke

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School of Medicine

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Student

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Clinical Science Departments

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Anesthesiology

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Anesthesiology, General, Vascular, High Risk Transplant & Critical Care

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Anesthesiology, Neuroanesthesia

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Anesthesiology, Regional

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Orthopaedic Surgery

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Institutes and Provost's Academic Units

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University Institutes and Centers

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Duke Institute for Brain Sciences

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Initiatives

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Duke Science & Society

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Neurosurgery

pubs.publication-status

Published

pubs.volume

69

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