Tag: Spinal anesthesia

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Spinal versus general anesthesia in robotic minimally invasive transforaminal lumbar interbody fusion: a comparative study on surgical outcomes

J Neurosurg Spine 44:99–107, 2026

This clinical study compares spinal anesthesia (SA) versus general anesthesia (GA) for robot-assisted minimally invasive transforaminal lumbar interbody fusion (RA‑MIS TLIF), reporting retrospective outcomes from 209 patients treated 2018–2024. Primary findings show SA patients had significantly shorter operative times, lower immediate postoperative pain scores, reduced estimated blood loss, and shorter hospital length of stay after propensity score matching and regression adjustment.

The authors contextualize results within advances in robotic spinal surgery and awake spine techniques, discuss safety and potential cost and opioid‑reduction benefits, and acknowledge limitations including retrospective design, single‑center data, and reduced matched cohort size. Conclusions support SA as a safe, efficient approach for RA‑MIS TLIF with calls for larger prospective studies and formal patient‑selection guidelines.

Spinal Anesthesia (SA) vs General Anesthesia (GA): In robot-assisted minimally invasive transforaminal lumbar interbody fusion (RA-MIS TLIF), SA significantly reduces operative times, postoperative pain, and hospital length of stay compared to GA, with no increase in complications or adverse outcomes.

Robotic Assistance Benefits: Robotic technology in spine surgery improves pedicle screw placement accuracy, reduces radiation exposure, and is associated with lower complication and revision rates, enhancing surgical safety and efficiency.

Study Design: A retrospective analysis of 209 patients (31 SA, 178 GA) from 2018–2024, with propensity score matching applied to control for confounders, allowing fair comparison between SA and GA cohorts for single-level procedures.

Key Outcomes (After Matching): SA cohort had shorter median total OR time (159 vs 283 min), procedure time (115 vs 201 min), lower intraoperative blood loss (25 vs 50 mL), lower first postoperative pain scores (median VAS 0 vs 5), and reduced mean length of stay (0.90 vs 2.64 days) compared to GA.

Patient Selection: The choice between SA and GA was based on patient preference and eligibility, with all SA cases being single-level procedures and comparable baseline demographics after matching.

Safety Profile: No increase in intraoperative or postoperative complications was observed with SA; screw placement accuracy remained high with robotic assistance.

Implications for Practice: Combining SA with RA-MIS TLIF offers a safe, efficient, and patient-centered approach that may lower healthcare costs and opioid requirements by reducing pain and hospitalization.

Limitations: Single-center, retrospective design with a relatively small matched cohort may limit generalizability; further prospective, multicenter studies are needed to validate these findings.

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Novel Merging of CT and MRI to Allow for Safe Navigation into Kambin’s Triangle for Percutaneous Lumbar Interbody Fusion

Operative Neurosurgery 24:331–340, 2023

For percutaneous lumbar fusion (percLIF), magnetic resonance imaging and computed tomography are critical to defining surgical corridors. Currently, these scans are performed separately, and surgeons then use fluoroscopy or neuromonitoring to guide instruments through Kambin’s triangle. However, anatomic variations and intraoperative positional changes are possible, meaning that safely accessing Kambin’s triangle remains a challenge because nerveroot visualization without endoscopes has not been thoroughly described.

OBJECTIVE: To overcome the known challenges of percLIF and reduce the likelihood of iatrogenic injuries by showing real-time locations of neural and bony anatomy.

METHODS: The authors demonstrate an intraoperative navigational platform that applies nerve root segmentation and image fusion to assist with percLIF. Five patients from a single institution were included.

RESULTS: Of the 5 patients, the mean age was 71 ± 8 years and 3 patients (60%) were female. One patient had general anesthesia while the remaining 4 patients underwent awake surgery with spinal anesthesia. The mean area for the L4-L5 Kambin’s triangle was 76.1 ± 14.5 mm2. A case example is shown where the side of approach was based on the fact that Kambin’s triangle was larger on one side compared with the other. The mean operative time was 170 ± 17 minutes, the mean blood loss was 32 ± 16 mL, and the mean hospital length of stay was 19.6 ± 8.3 hours. No patients developed postoperative complications.

CONCLUSION: This case series demonstrates the successful and safe application of nerve segmentation using magnetic resonance imaging/computed tomography fusion to perform percLIF and provide positive patient outcomes.

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