• Krizia Amoroso, Alexander P Hughes, and Ellen M Soffin.
• Department of Anesthesiology, Critical Care & Pain Management Hospital for Special Surgery.
• Curr Opin Anaesthesiol. 2023 Oct 1; 36 (5): 516524516-524.

Purpose Of ReviewThe impact of primary anesthetic technique on outcomes after spine surgery is controversial. Given frequent calls for well designed prospective comparative studies of neuraxial anesthesia vs. general anesthesia and recent reports of 'awake spine surgery' successes in the surgical literature, an updated evidence review is indicated.Recent FindingsSystematic reviews, population-based and retrospective cohort studies suggest few significant differences in important complications or global recovery between anesthetic techniques. On the basis of overall low-to-moderate quality evidence, neuraxial anesthesia is associated with statistically significant benefits for several individual outcomes compared with general anesthesia, including improved intraoperative hemodynamic stability, less postoperative nausea and vomiting, lower early pain scores and shorter length of hospital stay. There are ongoing calls for well designed, adequately powered prospective studies.SummaryOur understanding of the risks, benefits and comparative outcomes between neuraxial anesthesia and general anesthesia for spine surgery is evolving. Although the results derived from this body of literature suggest specific benefits of neuraxial anesthesia, further research is required before widespread recommendations for either technique can be made. Until then, both neuraxial anesthesia and general anesthesia are reasonable choices for lumbar spine surgery of short duration, in appropriately selected patients.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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