Title:
Spinal anesthesia versus general anesthesia for lumbar disc surgery
Author(s):
Bermede A.O., Yörükoğlu D.
Institute(s):
Ankara University School of Medicine, Dept of Anaesthesiology & Intensive Care, Ankara, Turkey
Text:
Background: Lumbar spine surgery can be performed using different anesthetic techniques such as general endotracheal anesthesia (GA) or spinal-based regional anesthesia (SA) (1). Several studies have been performed comparing these two anesthetic techniques and have revealed disperate results. SA is a safe but rarely used alternative to general anesthesia for lumbar disc surgery. It reduces blood loss, avoid pressure necrosis and nerve injuries, and it provides a more comfortable postoperative period (2). Regional anesthetics may also lower the incidence of pulmonary complications when compared to general anesthetics. some additional advantages of spinal anesthesia include early discharge from the post-anesthesia care unit, little pain and less nausea and vomiting. (3) The aim of this study was to compare the safety and efficacy of the intraoperative parameters and postoperative outcomes associated with SA and GA in patients undergoing lumbar disc surgery.
Materials and Methods: Following Institutional Review Board approval, 760 patients were evaluated who underwent lumbar disc surgery between January 2013 and December 2015. Demographic, clinical, laboratory and peroperative information was determined from the patients´ medical records. 
Results and Discussion: Spinal anesthesia (n=370) was associated with shorter length of stay (p < 0.001, Pearson Chi-Square test) comparing with general anesthesia (n=390). Nausea and vomiting was less common in SA group (p < 0.005, Pearson Chi-Square test). İn addition, headache was significantly less in SA group (p < 0.001, Pearson Chi-Square test).
Conclusion(s): Spinal anesthesia can be performed safely in patients undergoing lumbar spine surgery. It has the potential to reduce hospital stay, nausea and vomiting, and headache. Further prospective evaluaition will help to validate these findings.
References: 
1. Jellish WS, Thalji Z, Stevenson K, Shea J. A prospective randomized study comparing short and intermediate term perioperative outcome variables after spinal or general anesthesia for lumbar disc and laminectomy surgery. Anesth Analg 1996;83:559-564.
2. McLain RF, Kalfas I, Bell GR, et al. Comparison of spinal and general anesthesia in lumbar laminectomy surgery: a case-controlled analysis of 400 patients. J Neurosurg Spine 2005;2:17-22.
3. McLain RF, Bell GR, Kalfas I, Tetzlaff JE, Yoon HJ. Complications associated with lumbar laminectomy: a comparison of spinal versus general anesthesia. Spine 2004;29:2542-7.