1Orthopaedic Department, Ain Shams University, Cairo.
2Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina.
Neurosurg Focus. 2021 Dec;51(6):E6. doi: 10.3171/2021.9.FOCUS21456.
Despite tremendous advancements in biomedical science and surgical technique, spine surgeries are still associated with considerable rates of morbidity and mortality, particularly in the elderly. Multiple novel techniques have been employed in recent years to adequately treat spinal diseases while mitigating the perioperative morbidity associated with traditional spinal surgery. Some of these techniques include minimally invasive methods and novel anesthetic and analgesic methods. In recent years, awake spine surgery with spinal anesthesia has gained attention as an alternative to general anesthesia (GA). In this study, the authors retrospectively reviewed a single-institution Egyptian experience with awake spine surgery using spinal anesthesia during the COVID-19 pandemic.
Overall, 149 patients who were admitted to As-Salam International Hospital in Cairo for lumbar and lower thoracic spine surgeries, between 2019 and 2020, were retrospectively reviewed. Patient demographics and comorbidities were collected and analyzed. Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were assessed at different time intervals including preoperatively, immediately after surgery, and 1 year postoperatively. Patient satisfaction was queried through a questionnaire assessing patient preference for traditional anesthesia or spinal anesthesia.
Of the 149 patients who successfully received spine surgery with spinal anesthesia, there were 49 males and 100 females. The cohort age ranged from 22 to 85 years with a mean of 47.5 years. The operative time ranged from 45 to 300 minutes with a mean estimated blood loss (EBL) of 385 ± 156 mL. No major cardiopulmonary or intraoperative complications occurred, and patients were able to eat immediately after surgery. Patients were able to ambulate without an assistive device 6 to 8 hours after surgery. Decompression and fusion patients were discharged on postoperative days 2 and 3, respectively. VAS and ODI scores demonstrated excellent pain relief, which was maintained at the 1-year postoperative follow-up. No 30- or 90-day readmissions were recorded. Of 149 patients, 124 were satisfied with spinal anesthesia and would recommend spinal anesthesia to other patients. The remaining patients were not satisfied with spinal anesthesia but reported being pleased with their postoperative clinical and functional outcomes. One patient was converted to GA due to the duration of the procedure.
Patients who received spinal anesthesia for awake spine surgery experienced short stays in the hospital, no readmissions, patient satisfaction, and well-controlled pain. The results of this study have validated the growing body of literature that demonstrates that awake spine surgery with spinal anesthesia is safe and associated with superior outcomes compared with traditional GA. Additionally, the ability to address chronic debilitating conditions, such as spinal conditions, with minimal use of valuable resources, such as ventilators, proved useful during the COVID-19 pandemic and could be a model should other stressors on healthcare systems arise, especially in developing areas of the world.
尽管在生物医学科学和外科技术方面取得了巨大进步，但脊柱手术仍然存在相当高的发病率和死亡率，尤其是在老年人中。近年来，许多新的技术被应用于治疗脊柱疾病，同时减轻与传统脊柱手术相关的围手术期发病率。其中一些技术包括微创方法和新的麻醉和镇痛方法。近年来，在新冠肺炎大流行期间，清醒脊柱手术结合脊髓麻醉作为全身麻醉（GA）的替代方法引起了关注。在这项研究中，作者回顾了一家埃及机构在新冠肺炎大流行期间使用脊髓麻醉进行清醒脊柱手术的经验。
总共回顾了 2019 年至 2020 年期间在开罗的 As-Salam 国际医院接受腰椎和胸腰椎脊柱手术的 149 名患者。收集并分析了患者的人口统计学和合并症数据。在不同时间间隔（包括术前、术后即刻和术后 1 年）评估视觉模拟评分（VAS）和 Oswestry 残疾指数（ODI）评分。通过问卷调查询问患者对传统麻醉或脊髓麻醉的偏好，以评估患者满意度。
在成功接受脊髓麻醉的 149 名脊柱手术患者中，有 49 名男性和 100 名女性。队列年龄从 22 岁到 85 岁，平均年龄为 47.5 岁。手术时间从 45 分钟到 300 分钟不等，平均估计失血量（EBL）为 385±156mL。没有发生重大心肺或术中并发症，患者术后可立即进食。患者术后 6 至 8 小时即可无需辅助设备行走。减压和融合患者分别在术后第 2 天和第 3 天出院。VAS 和 ODI 评分显示出极好的疼痛缓解效果，并且在术后 1 年随访时仍然保持。没有记录到 30 天或 90 天的再入院。在 149 名患者中，124 名对脊髓麻醉满意，并会向其他患者推荐脊髓麻醉。其余患者对脊髓麻醉不满意，但对术后临床和功能结果感到满意。一名患者因手术时间延长而转为 GA。
接受清醒脊柱手术脊髓麻醉的患者住院时间短、无再入院、患者满意度高且疼痛得到良好控制。这项研究的结果验证了越来越多的文献表明，与传统 GA 相比，清醒脊柱手术结合脊髓麻醉是安全的，并具有更好的结果。此外，在新冠肺炎大流行期间，使用最小的有价值资源（如呼吸机）治疗慢性致残性疾病（如脊柱疾病）的能力非常有用，并且在出现其他对医疗系统的压力源时，尤其是在世界上发展中地区，这可能成为一种模式。
