Background:

The U.S. healthcare sector produces ∼10% of national greenhouse gas emissions, paradoxically harming human health. Neurosurgery is a resource-intensive specialty that likely contributes significantly, yet literature assessing this impact is absent. We investigate the difference in carbon emissions between spinal versus general anesthesia in lumbar spine surgery.

Methods:

100 patients underwent a single-level transforaminal lumbar interbody fusion (TLIF) from a single surgeon, 50 receiving spinal anesthesia and 50 receiving general anesthesia. Data was extracted from patient records. Amounts of anesthetics were calculated from intraoperative records and converted to carbon dioxide equivalents (CO₂e).

Results:

The median CO₂e for general anesthesia was 4,725 grams vs. 70 grams for spinal anesthesia (p=7.07e-18). Mean CO₂e for general anesthesia was 22,707 grams vs. 63 grams for spinal anesthesia. Desflurane use led to outsized carbon emissions. Carbon footprint comparisons are made to familiar units such as miles driven by a car, and are provided for a single TLIF, 50 TLIFs (single surgeon’s cases in a year), and 488,000 TLIFs (annual spinal fusions in the U.S.).

Conclusion:

This is one of the first known comparative carbon footprint study performed in neurosurgical literature. We highlight the dramatic carbon footprint reduction associated with using spinal anesthesia and reflect a single neurosurgeon’s change in practice from using only general anesthesia to incorporating the use of spinal anesthesia. Within general anesthesia patients, desflurane use was particularly harmful to the environment. We hope that our study will pave the way towards future research aimed at uncovering and reducing neurosurgery’s environmental impact.