Single-center series report of transforaminal lumbar interbody fusions under spinal anesthesia

Objective: Traditionally surgery for degenerative lumbar pathology is performed under general anesthesia (GA). There have been several studies that have pointed to the negative cognitive effects of general anesthesia, and patients often frequently request alternatives. Considering this, it is advantageous to offer alternative anesthesia strategies. Studies have demonstrated spinal anesthesia (SA) being utilized successfully in decompressive lumbar surgeries; however, there is limited data evaluating use in fusion surgeries. This study presents a single institution?s experience with spinal anesthesia for minimally invasive transforaminal lumbar interbody fusions. Methods: This is a retrospective review of a prospectively collected database analyzing 67 patients undergoing SA for lumbar fusion surgeries. Outcomes including data on safety, adverse events, and efficacy of SA were reviewed. In addition, patient demographics, complications, length of stay (LOS), disposition, and OR utilization time were recorded. Comparison to a similar cohort undergoing GA the year prior was completed. Results: There was no difference in length of stay (GA 3.2d vs SA 2.9d, p = 0.104). More patients in the SA group were discharged home compared to the GA group (SA-76% vs GA-56%, p = 0.02). There were no occurrences of pneumonia (PNA) or deep vein thromboses/pulmonary embolus (DVT/PE). There was no difference in incidence of urinary tract infections (UTI) (GA-5% vs SA-1%, p = 0.27). Total OR time was decreased in the SA group(SA164 min vs GA-200 min, p < 0.0001). Conclusions: SA is a safe alternative to GA and is time-efficient when compared to GA. SA can safely be considered as an option for patients undergoing lumbar instrumented fusion surgeries.