Lumbar Spinal Surgery

Modern lumbar spinal surgery ranges from disk excision through tiny incisions to extensive anterior-posterior fusions with allografts,^{[140] [141]} bone grafts, pedicle screws,^[142] and other methods, which may be associated with excessive blood loss, prolonged dependency, positioning problems, and neurologic monitoring with SSEPs and EMGs. The anesthetic techniques must be adapted to the particular type of surgery. Although these cases traditionally have been performed with general anesthesia, spinal or epidural anesthesia is being more commonly performed for simple disk excision.^[143] Lumbar spinal fusion can be performed with low thoracic epidural anesthesia (usually in combination with general anesthesia). The virtues of epidural anesthesia are less bleeding and improved postoperative epidural analgesia.^[144] Epidural catheters can also be placed by the anesthesiologist or surgeon during scoliosis surgery to facilitate postoperative analgesia.