DG Journal Club
BACKGROUND Spinal anesthesia (SA) is routinely used in obstetrics and orthopedic surgery but has not been widely adopted in lumbar spinal surgery (LSS). One of the perceived barriers is the learning curve for the neurosurgical and anesthesia team associated with managing a patient in the prone position under SA.
METHODS A retrospective cohort of 34 LSS cases under SA at our institution was examined. Operative time, corrected operative time per level, and complications were analyzed. The learning curve was assessed using a curve-fit regression analysis.
RESULTS Overall, 62% were female, with an average age and BMI of 60.7+10.8 years and 29.9+4.6 kg/m 2 . The average for each time segment was: OR arrival to incision (35.7+8.1 minutes), total surgical time (100.4+35.8 minutes), and procedure finish to OR exit (3.4+2.5 minutes). When the times were normalized to procedure type and analyzed sequentially, the average slope of all trendlines was 0.003+0.005 with correlation coefficients ranging from R 2 =0.0002-0.01, indicating no appreciable learning curve. Normalized PACU time was significantly shorter for overnight stay vs. same-day discharge (0.64 vs. 1.36, p=0.0005).
CONCLUSIONS Our data demonstrate the lack of a learning curve when SA is implemented in LSS cases by an anesthetic team already familiar with SA techniques for other procedures. Importantly, the surgical team was already familiar with the MIS approaches used in conjunction with SA. This manuscript highlights that the barriers to transitioning to SA for LSS may be fewer than perceived.