New Technique Bypasses Need for General Anesthesia

Using a new spinal anesthetic similar to an epidural, patients can now remain awake without pain while undergoing minimally invasive fusion and decompression procedures. UCSF is one of the first medical centers in the U.S. to offer this option, which shortens surgery time and avoids side effects of general anesthesia.

“Awake surgery eliminates a lot of the delirium associated with anesthesia that can prevent patients from returning to life and work,” said neurosurgeon Praveen Mummaneni, MD, who has performed over ten of these procedures in the last year. “Patients also have very rapid recovery and usually go home within 24 hours, instead of the 3 to 4 days for standard spine surgery.”

The average surgery time is about half that of open surgery, averaging 1 to 3 hours. Many of the same patients who are candidates for standard minimally invasive spine surgery may also be candidates for awake spine surgery. This includes patients with symptoms such as back pain, leg pain, weakness or numbness that have not responded to non-operative management.

For Janet Choy of Burlingame, CA, degenerative spondylolisthesis was causing numbness and pain in her right leg to gradually increase until she could not stand or walk for more than five minutes. “I chose UCSF and Dr. Mummaneni because I would be able to be awake and have a more noninvasive surgery,” she said.

In August 2018, Janet underwent a transforaminal interbody fusion to restore stability to her spine. “I didn’t feel any pain, so it was really a very good experience,” she said. “I was up walking the next day and climbing stairs and then I was off meds in 10 days. My pain is pretty minimal now from what it used to be, so I believe that it was successful so far and shortened my recovery.”

Awake spine surgery may also be an option for patients with other medical conditions that prevent them from undergoing general anesthesia. “It’s nice to be able to advance the field beyond what it’s been before,” said Dr. Mummaneni. “Hopefully this will continue to advance the field in the future.”