Spinal anesthesia for geriatric lumbar spine surgery: A comparative case series

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 ¼.002), consisted of more men (57% versus 36%, P ¼.01), and had a lower mean body mass index (28.3 versus 30.1, P ¼.03). 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 ¼.71). After controlling for age, sex, and body mass index, patients receiving SA had decreased estimated blood loss (b ¼ -75 mL; 95% confidence interval [CI], -140.6, -9.4; P ¼.025) and intraoperative intravenous fluid requirements (b ¼ -205 mL; 95% CI, -389.4, -21.0; P ¼.029), shorter postanesthesia care unit stays (b ¼ -41 minutes; 95% CI, -64.6, -16.9; P ¼.001), lower maximum visual analog scale pain scores (b ¼-0.89 points; 95% CI, -1.6, -0.1; P ¼.020), and decreased odds of receiving blood transfusion (odds ratio, 0.12; 95% CI, 0.01, 0.62; P ¼.45); 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.