Spinal fusion without general anesthesia

Spinal fusion is a surgical technique that has evolved significantly in recent years. It aims to stabilize a part of the spine that has been damaged or shows degenerative lesions.

During spinal fusion (waist or neck) two or more vertebrae are joined together (bone unification of the vertebrae) using metal materials or grafts to achieve stability in the spine. It is used to treat conditions such as:

• Spondylolisthesis – Spondylolysis
• Spondyloarthritis – Spondylitis
• Scoliosis
• Spinal stenosis
• Spinal Metastases
• Cervical Myelopathy
• Fractures

The spinal fusion technique can be applied at the cervical level but also at the lumbar level and with different approaches (anterior, posterior, lateral).

The progress of technology now allows the operation to be performed through small incisions without the need for muscle detachment (Percutaneous Spinal Fusion). Spinal fusion techniques are divided into two categories: open and percutaneous access.

Open spinal fusion is mainly applied in cases where correction of severe spinal deformity is required. Although this is a traditional approach, its use has been significantly reduced thanks to the development of transdermal techniques. Percutaneous methods offer faster recovery as they cause less damage to the tissues. However, in some cases, open access still offers better, long-term outcomes and for this reason, remains an option in selected patients.

The choice of the appropriate technique depends on the condition being treated and the anatomical area of the spine.

• Open (classical) method: A normal surgical incision is made in the lumbar region, through which the stabilizing special materials are placed – such as intercostal screws, intercorporeal cages, stabilization rods and grafts.
• Minimally Invasive Spinal Fusion (MIS):All of the above are placed through small skin incisions, with the help of an X-ray machine and with the application of special materials, limiting tissue damage and accelerating rehabilitation.
• Navigation-assisted spinal ligation: Whether applied openly or with MIS techniques, intraoperative navigation offers high precision in the placement of transverse screws, helping to increase the safety of the operation and limit radiation exposure.
• Robotically assisted spinal fusion: This is the most technologically advanced form of surgery. The specialized spine surgeon uses a robotic arm and navigation system to accurately prepare the placement of the materials, minimizing the risk of misalignment and complications due to improper placement.

The choice of the most appropriate technique depends on the type and degree of the problem. The operation should be performed by a qualified spine surgeon, as it requires careful planning and diligence to be achieved successfully.

The choice of the appropriate spinal fusion technique depends on specific criteria, such as:

• The number of vertebraethat need to be stabilized.
• The degree ofcorrection  in case of scoliosis or other deformity of the spine.
• The total costof the operation.
• The availability of medical equipmentand the necessary materials for the operation.

Pioneering method in spine surgery

Spinal fusion is usually performed under general anesthesia. In recent years, however, thanks to the progress of medical technology and the specialization of spine surgeons, it has become possible to perform spinal fusion without general anesthesia. This is an innovative approach that can be applied to vertebral ligaments of up to two levels of the spine – i.e. three consecutive vertebrae.

 Dr. Konstantinos Starantzis, a specialized spine  surgeon, is the first Greek doctor to apply this innovative Awake Fusion technique in Greece in recent years, combining safety, technological precision and faster rehabilitation for the patient.

This protocol can be applied in cases of spinal fusion involving up to two levels of the spine (three consecutive vertebrae). It is based on two axes:

• The use of modern robotic technology and special materials allows the operation to be performed through a single small hole, resulting in the minimization of surgical trauma, the reduction of postoperative pain and faster recovery.
• A special anesthesiological protocol where, instead of general anesthesia, dorsal anesthesia is applied in combination with peripheral nerve blocks, offering comfort to the patient and communication with the surgeon during the operation. The patient remains awake during surgery without feeling pain.

Spinal fusion without general anesthesia can be chosen for:

• Patients who cannot undergo general anesthesia for medical reasons
• Patients who do not wish to undergo general anesthesia for personal reasons

The duration of the operation is about 2 hours, while most patients are mobilized within a few hours after surgery.

• Avoiding the risks of general anesthesia
• Less postoperative pain
• Faster recovery and shorter hospitalization duration
• High precision thanks to modern technology

Spinal fusion without general anesthesia offers a safe, effective, and less traumatic option, contributing to faster recovery and a better patient experience.

Dr. Konstantinos Starantzis, Director of Spine and Scoliosis at the Athens Medical Center and Director of the Spine Department at the Osteon Orthopedic & Spine Clinic, with specialization and many years of experience in spine surgery, collaborates with a specialized team of anesthesiologists, well trained in Awake Fusion protocols. The interdisciplinary approach and the high degree of specialization guarantee the safety and success of the operation, even for patients with complex problems in the spine.

If you wish to find out if you are suitable for spinal fusion without general anesthesia, you can schedule a personalized evaluation with Dr. Starantzis.