Comparative analysis of perioperative characteristics and early outcomes in transforaminal endoscopic lumbar diskectomy: general anesthesia versus conscious sedation

Ankush I Bajaj; Natalie Yap; Peter B Derman; Sanjay Konakondla; Osama N Kashlan; Albert E Telfeian; Christoph P Hofstetter

doi:10.1007/s00586-023-07792-4

Comparative analysis of perioperative characteristics and early outcomes in transforaminal endoscopic lumbar diskectomy: general anesthesia versus conscious sedation

Eur Spine J. 2023 Aug;32(8):2896-2902. doi: 10.1007/s00586-023-07792-4. Epub 2023 Jul 14.

Authors

Ankush I Bajaj¹, Natalie Yap², Peter B Derman³, Sanjay Konakondla⁴, Osama N Kashlan⁵, Albert E Telfeian¹, Christoph P Hofstetter⁶

Affiliations

¹ Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
² Department of Neurological Surgery, University of Washington, Seattle, WA, USA.
³ Texas Back Institute, 6020 West Parker Rd, Plano, TX, 75093, USA.
⁴ Department of Neurosurgery, Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA, 17822, USA.
⁵ Department of Neurosurgery, University of Michigan, Ann Arbor, MI, 48109, USA.
⁶ Department of Neurological Surgery, University of Washington, Seattle, WA, USA. chh9045@neurosurgery.washington.edu.

PMID: 37450041
DOI: 10.1007/s00586-023-07792-4

Abstract

Purpose: To better understand how anesthesia type impacts patient selection and recovery in TELD, we conducted a multicenter prospective study which evaluates the differences in perioperative characteristics and outcomes between patients who underwent TELD with either general anesthesia (GA) or conscious sedation (CS).

Methods: We prospectively collected data from all TELD performed by five neurosurgeons at five different medical centers between February and October of 2022. The study population was dichotomized by anesthesia scheme, creating CS and GA cohorts. This study's primary outcomes were the Oswetry Disability Index (ODI) and the Visual Analog Scale (VAS) for back and leg pain, assessed preoperatively and at 2-week follow-up.

Results: A total of 52 patients underwent TELD for symptomatic lumbar disk herniation. Twenty-three patients received conscious sedation with local anesthesia, and 29 patients were operated on under general anesthesia. Patients who received CS were significantly older (60.0 vs. 46.7, p < 0.001) and had lower BMI (28.2 vs. 33.4, p = 0.005) than patients under GA. No intraoperative or anesthetic complications occurred in the CS and GA cohorts. Improvement at 2-week follow-up in ODI, VAS-back, and VAS-leg was greater in patients receiving CS relative to patients under GA, but these differences were not statistically significant.

Conclusion: In our multicenter prospective analysis of 52 patients undergoing TELD, we found that patients receiving CS were significantly older and had significantly lower BMI compared to patients under GA. On subgroup analysis, no statistically significant differences were found in the improvement of PROMs between patients in the CS and GA group.

Keywords: Conscious sedation with local anesthesia; Endoscopic spine surgery; General anesthesia; Lumbar disk herniation; Transforaminal endoscopic lumbar diskectomy.