(AS2) Assessment of Surgeons’ Attitude Towards Awake Spine Surgery Under Spinal Anesthesia

Introduction: Lumbar spine surgery can be performed under general anesthesia (GA) and under spinal anesthesia (SA). Although several studies have found that, in properly selected patients, SA offers several benefits including shorter operating room and procedure time, faster mobilization and better postoperative pain control, GA remains globally the most frequent anesthesia of choice, and the only one offered by many practices. As surgeon preference is an important factor in influencing patient’s anesthesia choice, we conducted a survey of spine surgeons’ attitudes and preferences towards SA for lumbar spine surgery. And we inquired whether a randomized trial showing reduced postoperative fatigue with SA would lead to change in surgeon’s considerations of SA for their practice.

Methods: A survey was emailed to 150 spine surgeons. Exposure and attitudes towards spine surgery under SA were elicited. A five-point Likert scale of agreement examined perceptions of SA, while attitudes towards SA were recorded by categorizing free text into themes.

Results: Seventy-five surgeons completed the survey, 50% response rate. Only 27% said they perform LSS under SA. Most surgeons, 83%, would recommend GA to a healthy patient undergoing lumbar laminectomy. Only 41% believes SA to be as safe as GA, and only 30% believes SA is associated with better postoperative pain control. The most common reasons why SA is not favored was lack of proven benefits over GA (65%). When asked if a randomized trial finds SA to lead to less postoperative fatigue, 50% said they would be more likely to offer SA, a significant increase from the baseline response of 27% (p=0.002).

Conclusion : Our survey indicates that the low adoption of SA for LSS is due to lack of surgeons’ belief in the benefits of SA over GA, and that a randomized patient-centered trial has the potential of changing surgeons’ perspective and increasing adoption of SA for LSS.