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Local Anesthesia for Biportal Endoscopic Lumbar Spinal Decompression

Friday, May 3, 2024

Presenting Author(s)

Jason Lim, BS (he/him/his)

Medical Student
Georgetown University School of Medicine

Co-Author(s)

Christoph P. Hofstetter, MD, PhD

Professor of Neurosurgery
University of Washington
Seattle, WA, US
PK

Patrick Kim, MD

Assistant Professor
Department of Neurological Surgery, University of South Florida, United States
SK

Samuel Kim, BA

Medical Student
University of Missouri-Kansas City School of Medicine, United States
Michael Levitt, MD

Professor of Neurosurgery
University of Washington, United States
DL

Do Hyeong Lim, BA

Research Scientist III
Department of Neurological Surgery, University of Washington, United States
MM

Michael Meyer, MD

Acting Instructor
Department of Neurological Surgery, University of Washington, United States
BR

Byeong Cheol Rim, MD, PhD

PI, Attending Physician
Rim's Neuro Clinic, United States
Sananthan Sivakanthan, MD

Resident
Department of Neurological Surgery, University of Washington
Seattle, Washington, United States

Introduction: Biportal endoscopic lumbar spinal decompression is a minimally invasive procedure for lumbar radiculopathy due to spondylosis or disc herniation. Anesthesia selection plays a pivotal role in patient outcomes. While general anesthesia has been the standard, our research highlights the feasibility of using local anesthesia, particularly for patients with comorbidities.

Methods: We retrospectively analyzed 166 patients who underwent biportal endoscopic lumbar spinal decompression with epidural anesthesia and intravenous sedation between 2022 and 2023 at Rim’s Neuro Clinic. To provide a comprehensive assessment, we conducted a systematic literature review from 2016 to 2020, focusing on visual analogue scale (VAS) scores pre- and post-surgery, follow-up periods of 4 weeks to 12 months, length of hospital stay (LOS), and complication rates.

Results: Based on preliminary analysis, in the local anesthesia group (166 patients, average age 67.2), VAS scores decreased from 7.2 before the operation to 1.3 during the 4-week to 12-month follow-up, reflecting a reduction of 6.9. The average LOS was 3.4 days, with only six minor complications (3.61%). In contrast, the general anesthesia group (85 patients, average age 65.7) saw VAS scores decrease from 6.3 to 0.5, a reduction of 5.8. Their average LOS was 5.7 days, with nine minor complications (10.6%).

Conclusion : Our study emphasizes the feasibility of local anesthesia in biportal endoscopic lumbar spinal decompression. While general anesthesia has traditionally been the primary choice for minimally invasive spine surgeries, our findings suggest that local anesthesia has similar outcomes as general anesthesia. This suggests local anesthesia, without the need of intubation, could be used as a practical alternative, particularly for patients with underlying health conditions. The evidence supports considering local anesthesia as a viable and safe option for biportal endoscopic lumbar spinal decompression.