Retrospective Review of Lumbar Disc Surgeries Performed Under Spinal Anesthesia During the COVID-19 Pandemic: Can Spinal Anesthesia Be a Practical Alternative for Surgical Procedures in Pandemic Periods?

Yıl 2025, Cilt: 7 Sayı: 3, 614 - 20, 09.09.2025

Kenan Kart , Nagehan Ümit Karacan , Duygu Taşkın , Ufuk Karadavut

Öz

Aim: Recent studies report that spinal anesthesia may be an alternative to general anesthesia in lumbar surgeries. Considering the benefits that spinal anesthesia provides to patients over general anesthesia, it is a positive development. Depending on the importance and priority of the work to be done, surgical interventions must be performed when necessary. In the present study, a retrospective review was made regarding Lumbar Disc Herniation (LDH) surgeries under spinal anesthesia in our hospital during the COVID-19 pandemic.
Material and Method: LDH surgeries performed under spinal anesthesia in 184 patients between March 14, 2020, and December 31, 2022, were evaluated retrospectively in the present study.
Results: A total of 196 patient files were scanned and the files of 184 were examined retrospectively. A total of 12 patients were excluded from the study because of insufficient data. It was found that the surgery times of patients with surgical levels L5-S1 were significantly higher. The first postoperative analgesia requirement was significantly later in patients who underwent surgery at the L5-S1 level. Ephedrine was administered to 13 of the patients and atropine was administered to 14 of them. Perioperatively, 14 of the patients required additional analgesia. Postspinal headache developed in 16 of the patients and urinary retention developed in 12. SAP, DAP, and MAP of the patients decreased significantly after the intraoperative spinal anesthesia.
Conclusion: The results of the present study showed that spinal anesthesia is safe in awake lumbar disc surgery patients, which supports the increasing literature data emphasizing the superiority of spinal anesthesia in awake lumbar surgery procedures. It was also shown that spinal anesthesia can be preferred for sustainable surgery during pandemic periods when the need for ventilators is intense and opportunities are limited.

Anahtar Kelimeler

Spinal anesthesia , lomber disc hernia , COVID-19 , pandemic period , sustainable resource use

Etik Beyan

After obtaining ethics committee approval from Karabük University, Non-Interventional Ethics Committee (No: 2023/1271, Date: 24.02.2023).

Kaynakça

• Yavuzer MG. Evolution of bipedalism. In: Yavuzer MG, ed. Comparative Kinesiology of the Human Body. Amsterdam: Elsevier; 2020:489-97.
• GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1223-49.
• Amin RM, Andrade NS, Neuman BJ. Lumbar disc herniation. Curr Rev Musculoskelet Med. 2017;10:507-16.
• Evans L, O'Donohoe T, Morokoff A, Drummond K. The role of spinal surgery in the treatment of low back pain. Med J Aust. 2023;218:40-5.
• Nicassio N, Bobicchio P, Umari M, Tacconi L. Lumbar microdiscectomy under epidural anaesthesia with the patient in the sitting position: a prospective study. J Clin Neurosci. 2010;17:1537-40.
• Nazon D, Abergel G, Hatem CM. Critical care in orthopedic and spine surgery. Crit Care Clin. 2003;19:33-53.
• Şahin AS, Türker G, Bekar A, et al. A comparison of spinal anesthesia characteristics following intrathecal bupivacaine or levobupivacaine in lumbar disc surgery. Eur Spine J. 2014;23:695-700.
• Zorrilla-Vaca A, Healy RJ, Mirski MA. A comparison of regional versus general anesthesia for lumbar spine surgery: a meta-analysis of randomized studies. J Neurosurg Anesthesiol. 2017;29:415-25.
• Smith G, D’Cruz JR, Rondeau B, Goldman J. General anesthesia for surgeons. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Aug 5.
• Sagat P, Bartík P, Prieto González P, et al. Impact of COVID-19 quarantine on low back pain intensity, prevalence, and associated risk factors among adult citizens residing in Riyadh (Saudi Arabia): a cross-sectional study. Int J Environ Res Public Health. 2020;17:7302.
• Moretti A, Menna F, Aulicino M, et al. Characterization of home working population during COVID-19 emergency: a cross-sectional analysis. Int J Environ Res Public Health. 2020;17:6284.
• Kolcun JPG, Brusko GD, Basil GW, et al. Endoscopic transforaminal lumbar interbody fusion without general anesthesia: operative and clinical outcomes in 100 consecutive patients with a minimum 1-year follow-up. Neurosurg Focus. 2019;46:E14.
• Martin BI, Mirza SK, Spina N, et al. Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States. 2004 to 2015. Spine (Phila Pa 1976). 2019;44:369-76.
• Sekerak R, Mostafa E, Morris MT, et al. Comparative outcome analysis of spinal anesthesia versus general anesthesia in lumbar fusion surgery. J Clin Orthop Trauma. 2020;13:122-6.
• De Cassai A, Geraldini F, Boscolo A, et al. General anesthesia compared to spinal anesthesia for patients undergoing lumbar vertebral surgery: a meta-analysis of randomized controlled trials. J Clin Med. 2020;10:102.
• Köksal V, Şen A, Erdivanlı B, Özdemir B. Retrospective evaluation of outcomes in lumbar disc surgery with spinal anesthesia. J Clin Exp Invest. 2014;5:54-8.
• Wahood W, Yolcu Y, Alvi MA, et al. Assessing the differences in outcomes between general and non-general anesthesia in spine surgery: results from a national registry. Clin Neurol Neurosurg. 2019;180:79-86.
• Urick D, Sciavolino B, Wang TY, et al. Perioperative outcomes of general versus spinal anesthesia in the lumbar spine surgery population: a systematic review and meta-analysis of data from 2005 through 2021. J Clin Orthop Trauma. 2022;30:101923.
• Lee JK, Park JH, Hyun SJ, et al. Regional anesthesia for lumbar spine surgery: can it be a standard in the future?. Neurospine. 2021;18:733-40.
• West JL, De Biase G, Bydon M, et al. What is the learning curve for lumbar spine surgery under spinal anesthesia?. World Neurosurg. 2022;158:e310-6.
• American Society of Anesthesiologists. Practice advisory for the prevention, diagnosis, and management of postdural puncture headache. ASA Guidelines. 2020. https://www.asahq.org/standards-and-guidelines access date 22.04.2023.
• Lawrie CM, Ong AC, Hernandez VH, et al. Incidence and risk factors for postoperative urinary retention in total hip arthroplasty performed under spinal anesthesia. J Arthroplasty. 2017;32:3748-51.
• Della Corte L, Mercorio A, Morra I, et al. Spinal anesthesia versus general anesthesia in gynecological laparoscopic surgery: a systematic review and meta-analysis. Gynecol Obstet Invest. 2022;87:1–11.
• Garg B, Ahuja K, Sharan AD. Regional anesthesia for spine surgery. J Am Acad Orthop Surg. 2022;30:809-19.
• Baenziger B, Nadi N, Doerig R, et al. Regional versus general anesthesia: effect of anesthetic techniques on clinical outcome in lumbar spine surgery: a prospective randomized controlled trial. J Neurosurg Anesthesiol. 2020;32:29-35.
• Attari MA, Mirhosseini SA, Honarmand A, Safavi MR. Spinal anesthesia versus general anesthesia for elective lumbar spine surgery: a randomized clinical trial. J Res Med Sci. 2011;16:524-9.
• Soh TLT, Ho SWL, Yap WMQ, Oh JY. Spine surgery and COVID-19: challenges and strategies from the front lines. J Bone Joint Surg Am. 2020;102:e56.
• Zhong QY, Liu YY, Luo Q, et al. Spinal anaesthesia for patients with coronavirus disease 2019 and possible transmission rates in anaesthetists: retrospective, single-centre, observational cohort study. Br J Anaesth. 2020;125:e254-6. Erratum in: Br J Anaesth. 2020;125:408.
• Uppal V, Sondekoppam RV, Landau R, et al. Neuraxial anaesthesia and peripheral nerve blocks during the COVID-19 pandemic: a literature review and practice recommendations. Anaesthesia. 2020;75:1350-63.
• Donnally CJ 3rd, Shenoy K, Vaccaro AR, et al. Triaging spine surgery in the COVID-19 era. Clin Spine Surg. 2020;33:129-30.
• Soffin EM, Reisener MJ, Sama AA, et al. Essential spine surgery during the COVID-19 pandemic: a comprehensive framework for clinical practice from a specialty orthopedic hospital in New York City. HSS J. 2020;16:29-35.
• Turcotte JJ, Gelfand JM, Jones CM, Jackson RS. Development of a low-resource operating room and a wide-awake orthopedic surgery program during the COVID-19 pandemic. Surg Innov. 2021;28:183-8.