Background:

Spinal anesthesia is an effective modality for lumbar surgeries. Patient eligibility with respect to medical comorbidities remains a topic of debate. Obesity (BMI ≥30), anxiety, obstructive sleep apnea, re-operation at the same level, and multilevel operations have variously been reported as relative contraindications. We hypothesize that patients undergoing common lumbar surgeries with these comorbidities do not experience greater rates of complications when compared to controls.

Methods:

We analyzed a prospectively collected database of patients undergoing thoracolumbar surgery under spinal anesthesia and identified 422 cases. Surgeries were under three hours, the duration of action of intrathecal bupivacaine, and include microdiscectomies, laminectomies, and both single and multi-level fusions. Procedures were performed by a single surgeon at a single academic center. In overlapping groups, 149 patients had a BMI ≥30, 95 had diagnosed anxiety, 79 underwent multilevel surgery, 98 had obstructive sleep apnea, and 65 had a prior operation at the same level. The control group included 132 patients who did not have these risk factors. Differences in important perioperative outcomes were assessed.

Results:

There were no statistically significant differences in intraoperative and post-operative complications save two cases of pneumonia in the anxiety group and one case in the reoperative group. There were also no significant differences for patients with multiple risk factors. Rates of spinal fusion were similar among groups, though mean length of stay and operative time were different.

Conclusions:

Spinal anesthesia is a safe option for patients with significant comorbidities and can be considered for most patients undergoing routine lumbar surgeries.