Assessment of surgeons’ attitude towards awake spine surgery under spinal anesthesia

Gaetano De Biase, Rickey E. Carter, Andrea Otamendi-Lopez, Diogo Garcia, Selby Chen, Elird Bojaxhi, Alfredo Quinones-Hinojosa, Kingsley Abode-Iyamah

Research output: Contribution to journalArticlepeer-review


Background: General anesthesia (GA) and spinal anesthesia (SA) have been adopted for lumbar spine surgery (LSS), but GA is used far more widely. We conducted a survey of spine surgeons to explore their attitudes and preferences regarding awake spine surgery under SA. 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). Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)48-53
Number of pages6
JournalJournal of Clinical Neuroscience
StatePublished - Jan 2023


  • Awake MIS-TLIF
  • Awake spine surgery
  • Patient-centered outcomes
  • Randomized trials
  • Spinal anesthesia
  • Survey

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology
  • Physiology (medical)


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