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. 2020 Oct;14(5):713-721.
doi: 10.14444/7103. Epub 2020 Oct 12.

Spinal Anesthesia for Geriatric Lumbar Spine Surgery: A Comparative Case Series

Noah L Lessing  1 , Charles C Edwards 2nd  1 , Clayton L Dean  1 , Olive H Waxter  1 , Charles Lin  2 , Ryan A Curto  1 , Charles H Brown 4th  3
Affiliations

Spinal Anesthesia for Geriatric Lumbar Spine Surgery: A Comparative Case Series

Noah L Lessing et al. Int J Spine Surg. 2020 Oct.

Abstract

Background: The use of spinal anesthesia (SA) as opposed to general anesthesia (GA) during elective lumbar spine surgery is an emerging technique and represents a potentially modifiable factor to limit perioperative complications. Few studies, however, have compared these anesthetic techniques in an elderly population. The aim of this study is to determine if SA is a safe alternative to GA for lumbar spine surgery in elderly patients.

Methods: A retrospective, consecutive case series study was performed. All patients aged 70 years and older who underwent lumbar spine decompression or combined decompression and fusion using either SA or GA during a 2-year period at a single institution were identified. Demographics and perioperative outcomes were compared.

Results: Of all patients meeting the inclusion criteria, 56 patients (19%) received SA and 239 (81%) received GA. Patients receiving SA were slightly older (median age, 77 years versus 75 years, P = .002), consisted of more men (57% versus 36%, P = .01), and had a lower mean body mass index (28.3 versus 30.1, P = .03). Indications for surgery and type of surgery were similar between groups. On average, operative times with SA were 101 minutes versus 103 minutes with GA (P = .71). After controlling for age, sex, and body mass index, patients receiving SA had decreased estimated blood loss (β = -75 mL; 95% confidence interval [CI], -140.6, -9.4; P = .025) and intraoperative intravenous fluid requirements (β = -205 mL; 95% CI, -389.4, -21.0; P = .029), shorter postanesthesia care unit stays (β = -41 minutes; 95% CI, -64.6, -16.9; P = .001), lower maximum visual analog scale pain scores (β = -0.89 points; 95% CI, -1.6, -0.1; P = .020), and decreased odds of receiving blood transfusion (odds ratio, 0.12; 95% CI, 0.01, 0.62; P = .45); there were no significant differences in operative time, length of stay, nausea, or oral morphine equivalents consumed per day. Complication rates were similar between groups.

Conclusion: Spinal anesthesia is a reasonable, safe alternative to general anesthesia for lumbar spine surgery in elderly patients with degenerative conditions.

Keywords: geriatrics; lumbar decompression; lumbar fusion; spinal anesthesia.

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Conflict of interest statement

Disclosures and COI: The authors do not have any proprietary interests in the materials described in this article, and do not report any conflicts of interest. The authors have not received grant support or research funding, except for Dr Charles H. Brown, in the form of Career Development Core of the Johns Hopkins Pepper Older Americans Independence Center, NIA P30AG021334.

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