{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T20:56:26Z","timestamp":1793998586771,"version":"4.8.0"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Awake, endoscopic spinal fusion has been utilized as an ultra\u2013minimally invasive surgery technique to accomplish the goals of spinal fixation, fusion, and disc height restoration. While many techniques exist for this approach, this series represents a single institution\u2019s experience with a large cohort and the evolution of this method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The medical records of a consecutive series of 400 patients treated over a 10-year period were retrospectively reviewed. Endoscopic decompression, expandable intervertebral spacer deployment, and percutaneous screws were combined with liposomal bupivacaine to allow for the surgery to be performed without general endotracheal anesthesia (GETA) in the vast majority of cases. Clinical and radiographic postoperative results were reviewed with special attention to surgical complications, in particular dorsal root ganglion (DRG) irritation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>All patients underwent surgery successfully without conversion to an open operation. Their mean age was 69.1 \u00b1 10.4 years, and 42% of the patients were male. A total of 509 levels were fused, with the most common indication being spondylolisthesis (67.5%). The mean operative time was 84.6 \u00b1 31.4 minutes, the mean intraoperative blood loss was 98 \u00b1 63 ml, and the mean hospital length of stay was 1.93 \u00b1 1.1 nights. Overall, 4.3% of the patients underwent planned GETA due to comorbidities, and 2% were converted to GETA intraoperatively. Eighty percent of the patients experienced &gt; 75% improvement in leg pain, and 52% experienced &gt; 75% improvement in axial back pain. Complications included transient DRG irritation (23%), adjacent-level disease requiring reoperation (3.5%), inadequate decompression (2.3%), and nonunion (1.8%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>This large case series demonstrates that awake, endoscopic spinal fusion is a viable option with acceptable clinical and radiographic results in a select patient population. Meticulous attention to detail is required to limit the rate of DRG irritation, achieve interbody height restoration, and mitigate nonunions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.9.spine2431","type":"journal-article","created":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T21:00:54Z","timestamp":1736542854000},"page":"435-442","source":"Crossref","is-referenced-by-count":12,"title":["Awake, endoscopic lumbar interbody spinal fusion: 10 years of experience with the first 400 cases"],"prefix":"10.3171","volume":"42","author":[{"given":"Michael Y.","family":"Wang","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Grossman","sequence":"additional","affiliation":[{"name":"Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Neurosurg Focus","first-page":"E13","article-title":"Endoscopic minimally invasive transforaminal interbody fusion without general anesthesia: initial clinical experience with 1-year follow-up","volume":"40","author":"Wang MY","year":"2016","unstructured":"Wang MY, Grossman J. Endoscopic minimally invasive transforaminal interbody fusion without general anesthesia: initial clinical experience with 1-year follow-up. Neurosurg Focus. 2016;40(2):E13."},{"issue":"4","key":"b2","series-title":"J Neurosurg Spine","first-page":"411","article-title":"Development of an Enhanced Recovery After Surgery (ERAS) approach for lumbar spinal fusion","volume":"26","author":"Wang MY","year":"2017","unstructured":"Wang MY, Chang PY, Grossman J. Development of an Enhanced Recovery After Surgery (ERAS) approach for lumbar spinal fusion. J Neurosurg Spine. 2017;26(4):411\u2013418."},{"issue":"4","key":"b3","series-title":"Neurosurg Focus","first-page":"E14","article-title":"Endoscopic transformational lumbar interbody fusion without general anesthesia: clinical and operative outcomes in 100 consecutive patients with minimum 1-year follow-up","volume":"46","author":"Kolcun J","year":"2019","unstructured":"Kolcun J, Brusko G, Basil G, Epstein R, Wang M. Endoscopic transformational lumbar interbody fusion without general anesthesia: clinical and operative outcomes in 100 consecutive patients with minimum 1-year follow-up. Neurosurg Focus. 2019;46(4):E14."},{"key":"b4","series-title":"World Neurosurg","first-page":"154","article-title":"Pearls and pitfalls of awake spine surgery: a simplified patient-selection algorithm","volume":"161","author":"Letchuman V","year":"2022","unstructured":"Letchuman V, Agarwal N, Mummaneni VP,  Pearls and pitfalls of awake spine surgery: a simplified patient-selection algorithm. World Neurosurg. 2022;161:154\u2013155."},{"issue":"6","key":"b5","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Spinal anesthesia in awake surgical procedures of the lumbar spine: a systematic review and meta-analysis of 3709 patients","volume":"51","author":"Perez-Roman RJ","year":"2021","unstructured":"Perez-Roman RJ, Govindarajan V, Bryant JP, Wang MY. Spinal anesthesia in awake surgical procedures of the lumbar spine: a systematic review and meta-analysis of 3709 patients. Neurosurg Focus. 2021;51(6):E7."},{"key":"b6","series-title":"World Neurosurg","first-page":"402","article-title":"The history and controversy over Kambin\u2019s triangle: a historical analysis of the lumbar transforaminal corridor for endoscopic surgical approaches","volume":"123","author":"Tumial\u00e1n LM","year":"2019","unstructured":"Tumial\u00e1n LM, Madhavan K, Godzik J, Wang MY. The history and controversy over Kambin\u2019s triangle: a historical analysis of the lumbar transforaminal corridor for endoscopic surgical approaches. World Neurosurg. 2019;123:402\u2013408."},{"issue":"1","key":"b7","series-title":"Neurosurgery","first-page":"150","article-title":"Safe electromyography stimulation thresholds within Kambin\u2019s triangle during endoscopic transforaminal lumbar interbody fusion","volume":"91","author":"Li Y","year":"2022","unstructured":"Li Y, Wang MY. Safe electromyography stimulation thresholds within Kambin\u2019s triangle during endoscopic transforaminal lumbar interbody fusion. Neurosurgery. 2022;91(1):150\u2013158."},{"issue":"2","key":"b8","series-title":"World J Surg","first-page":"407","article-title":"Enhanced Recovery After Surgery (ERAS) program attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: a prospective randomized controlled trial","volume":"36","author":"Ren L","year":"2012","unstructured":"Ren L, Zhu D, Wei Y,  Enhanced Recovery After Surgery (ERAS) program attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: a prospective randomized controlled trial. World J Surg. 2012;36(2):407\u2013414."},{"issue":"4","key":"b9","series-title":"JPEN J Parenter Enteral Nutr","first-page":"389","article-title":"Rhoads lecture 2011: Insulin resistance and enhanced recovery after surgery","volume":"36","author":"Ljungqvist O. Jonathan E","year":"2012","unstructured":"Ljungqvist O. Jonathan E. Rhoads lecture 2011: Insulin resistance and enhanced recovery after surgery. JPEN J Parenter Enteral Nutr. 2012;36(4):389\u2013398."},{"issue":"1","key":"b10","series-title":"Curr Opin Clin Nutr Metab Care","first-page":"69","article-title":"Insulin resistance: a marker of surgical stress","volume":"2","author":"Thorell A","year":"1999","unstructured":"Thorell A, Nygren J, Ljungqvist O. Insulin resistance: a marker of surgical stress. Curr Opin Clin Nutr Metab Care. 1999;2(1):69\u201378."},{"issue":"1","key":"b11","series-title":"Eur Surg Res","first-page":"24","article-title":"Fast-track surgery\u2014conditions and challenges in postsurgical treatment: a review of elements of translational research in enhanced recovery after surgery","volume":"49","author":"Hoffmann H","year":"2012","unstructured":"Hoffmann H, Kettelhack C. Fast-track surgery\u2014conditions and challenges in postsurgical treatment: a review of elements of translational research in enhanced recovery after surgery. Eur Surg Res. 2012;49(1):24\u201334."},{"issue":"1","key":"b12","series-title":"Int J Surg","first-page":"16","article-title":"Implementation of ERAS and how to overcome the barriers","volume":"7","author":"Kahokehr A","year":"2009","unstructured":"Kahokehr A, Sammour T, Zargar-Shoshtari K, Thompson L, Hill AG. Implementation of ERAS and how to overcome the barriers. Int J Surg. 2009;7(1):16\u201319."},{"issue":"Suppl 4","key":"b13","series-title":"Neurosurgery","first-page":"S108","article-title":"Minimally invasive spinal surgery in the elderly: does it make sense?","volume":"77","author":"Shamji MF","year":"2015","unstructured":"Shamji MF, Goldstein CL, Wang M, Uribe JS, Fehlings MG. Minimally invasive spinal surgery in the elderly: does it make sense?. Neurosurgery. 2015;77(Suppl 4):S108\u2013S115."},{"issue":"6","key":"b14","series-title":"Anesthesiology","first-page":"1184","article-title":"Brief preoperative screening for frailty and cognitive impairment predicts delirium after spine surgery","volume":"133","author":"Susano MJ","year":"2020","unstructured":"Susano MJ, Grasfield RH, Friese M,  Brief preoperative screening for frailty and cognitive impairment predicts delirium after spine surgery. Anesthesiology. 2020;133(6):1184\u20131191."},{"issue":"Suppl 1","key":"b15","series-title":"J Spine Surg","first-page":"S41","article-title":"The benefit zone of full-endoscopic spine surgery","volume":"5","author":"Hasan S","year":"2019","unstructured":"Hasan S, H\u00e4rtl R, Hofstetter CP. The benefit zone of full-endoscopic spine surgery. J Spine Surg. 2019;5(Suppl 1):S41\u2013S56."},{"issue":"2","key":"b16","series-title":"J Am Coll Surg","first-page":"136","article-title":"American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. Postoperative delirium in older adults: best practice statement from the American Geriatrics Society","volume":"220","year":"2015","unstructured":"American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. Postoperative delirium in older adults: best practice statement from the American Geriatrics Society. J Am Coll Surg. 2015;220(2):136\u2013148.e1."},{"issue":"4","key":"b17","series-title":"Neurosurg Focus","first-page":"E3","article-title":"The safety profile of lumbar spinal surgery in elderly patients 85 years and older","volume":"39","author":"Wang MY","year":"2015","unstructured":"Wang MY, Widi G, Levi AD. The safety profile of lumbar spinal surgery in elderly patients 85 years and older. Neurosurg Focus. 2015;39(4):E3."},{"issue":"6","key":"b18","series-title":"J Spinal Disord Tech","first-page":"324","article-title":"Acute hospital costs after minimally invasive versus open lumbar interbody fusion: data from a US national database with 6106 patients","volume":"25","author":"Wang MY","year":"2012","unstructured":"Wang MY, Lerner J, Lesko J, McGirt MJ. Acute hospital costs after minimally invasive versus open lumbar interbody fusion: data from a US national database with 6106 patients. J Spinal Disord Tech. 2012;25(6):324\u2013328."},{"issue":"6","key":"b19","series-title":"J Neurosurg Spine","first-page":"694","article-title":"An analysis of the differences in the acute hospitalization charges following minimally invasive versus open posterior lumbar interbody fusion","volume":"12","author":"Wang MY","year":"2010","unstructured":"Wang MY, Cummock MD, Yu Y, Trivedi RA. An analysis of the differences in the acute hospitalization charges following minimally invasive versus open posterior lumbar interbody fusion. J Neurosurg Spine. 2010;12(6):694\u2013699."},{"issue":"3","key":"b20","series-title":"Neurosurg Clin N Am","first-page":"419","article-title":"Lateral prepsoas (oblique) approach nuances","volume":"29","author":"DiGiorgio AM","year":"2018","unstructured":"DiGiorgio AM, Edwards CS, Virk MS, Chou D. Lateral prepsoas (oblique) approach nuances. Neurosurg Clin N Am. 2018;29(3):419\u2013426."},{"issue":"2","key":"b1","series-title":"Neurosurg Focus","first-page":"E13","article-title":"Endoscopic minimally invasive transforaminal interbody fusion without general anesthesia: initial clinical experience with 1-year follow-up","volume":"40","author":"Wang MY","year":"2016","unstructured":"Wang MY, Grossman J. Endoscopic minimally invasive transforaminal interbody fusion without general anesthesia: initial clinical experience with 1-year follow-up. Neurosurg Focus. 2016;40(2):E13."},{"issue":"4","key":"b2","series-title":"J Neurosurg Spine","first-page":"411","article-title":"Development of an Enhanced Recovery After Surgery (ERAS) approach for lumbar spinal fusion","volume":"26","author":"Wang MY","year":"2017","unstructured":"Wang MY, Chang PY, Grossman J. Development of an Enhanced Recovery After Surgery (ERAS) approach for lumbar spinal fusion. J Neurosurg Spine. 2017;26(4):411\u2013418."},{"issue":"4","key":"b3","series-title":"Neurosurg Focus","first-page":"E14","article-title":"Endoscopic transformational lumbar interbody fusion without general anesthesia: clinical and operative outcomes in 100 consecutive patients with minimum 1-year follow-up","volume":"46","author":"Kolcun J","year":"2019","unstructured":"Kolcun J, Brusko G, Basil G, Epstein R, Wang M. Endoscopic transformational lumbar interbody fusion without general anesthesia: clinical and operative outcomes in 100 consecutive patients with minimum 1-year follow-up. Neurosurg Focus. 2019;46(4):E14."},{"key":"b4","series-title":"World Neurosurg","first-page":"154","article-title":"Pearls and pitfalls of awake spine surgery: a simplified patient-selection algorithm","volume":"161","author":"Letchuman V","year":"2022","unstructured":"Letchuman V, Agarwal N, Mummaneni VP,  Pearls and pitfalls of awake spine surgery: a simplified patient-selection algorithm. World Neurosurg. 2022;161:154\u2013155."},{"issue":"6","key":"b5","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Spinal anesthesia in awake surgical procedures of the lumbar spine: a systematic review and meta-analysis of 3709 patients","volume":"51","author":"Perez-Roman RJ","year":"2021","unstructured":"Perez-Roman RJ, Govindarajan V, Bryant JP, Wang MY. Spinal anesthesia in awake surgical procedures of the lumbar spine: a systematic review and meta-analysis of 3709 patients. Neurosurg Focus. 2021;51(6):E7."},{"key":"b6","series-title":"World Neurosurg","first-page":"402","article-title":"The history and controversy over Kambin\u2019s triangle: a historical analysis of the lumbar transforaminal corridor for endoscopic surgical approaches","volume":"123","author":"Tumial\u00e1n LM","year":"2019","unstructured":"Tumial\u00e1n LM, Madhavan K, Godzik J, Wang MY. The history and controversy over Kambin\u2019s triangle: a historical analysis of the lumbar transforaminal corridor for endoscopic surgical approaches. World Neurosurg. 2019;123:402\u2013408."},{"issue":"1","key":"b7","series-title":"Neurosurgery","first-page":"150","article-title":"Safe electromyography stimulation thresholds within Kambin\u2019s triangle during endoscopic transforaminal lumbar interbody fusion","volume":"91","author":"Li Y","year":"2022","unstructured":"Li Y, Wang MY. Safe electromyography stimulation thresholds within Kambin\u2019s triangle during endoscopic transforaminal lumbar interbody fusion. Neurosurgery. 2022;91(1):150\u2013158."},{"issue":"2","key":"b8","series-title":"World J Surg","first-page":"407","article-title":"Enhanced Recovery After Surgery (ERAS) program attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: a prospective randomized controlled trial","volume":"36","author":"Ren L","year":"2012","unstructured":"Ren L, Zhu D, Wei Y,  Enhanced Recovery After Surgery (ERAS) program attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: a prospective randomized controlled trial. World J Surg. 2012;36(2):407\u2013414."},{"issue":"4","key":"b9","series-title":"JPEN J Parenter Enteral Nutr","first-page":"389","article-title":"Rhoads lecture 2011: Insulin resistance and enhanced recovery after surgery","volume":"36","author":"Ljungqvist O. Jonathan E","year":"2012","unstructured":"Ljungqvist O. Jonathan E. Rhoads lecture 2011: Insulin resistance and enhanced recovery after surgery. JPEN J Parenter Enteral Nutr. 2012;36(4):389\u2013398."},{"issue":"1","key":"b10","series-title":"Curr Opin Clin Nutr Metab Care","first-page":"69","article-title":"Insulin resistance: a marker of surgical stress","volume":"2","author":"Thorell A","year":"1999","unstructured":"Thorell A, Nygren J, Ljungqvist O. Insulin resistance: a marker of surgical stress. Curr Opin Clin Nutr Metab Care. 1999;2(1):69\u201378."},{"issue":"1","key":"b11","series-title":"Eur Surg Res","first-page":"24","article-title":"Fast-track surgery\u2014conditions and challenges in postsurgical treatment: a review of elements of translational research in enhanced recovery after surgery","volume":"49","author":"Hoffmann H","year":"2012","unstructured":"Hoffmann H, Kettelhack C. Fast-track surgery\u2014conditions and challenges in postsurgical treatment: a review of elements of translational research in enhanced recovery after surgery. Eur Surg Res. 2012;49(1):24\u201334."},{"issue":"1","key":"b12","series-title":"Int J Surg","first-page":"16","article-title":"Implementation of ERAS and how to overcome the barriers","volume":"7","author":"Kahokehr A","year":"2009","unstructured":"Kahokehr A, Sammour T, Zargar-Shoshtari K, Thompson L, Hill AG. Implementation of ERAS and how to overcome the barriers. Int J Surg. 2009;7(1):16\u201319."},{"issue":"Suppl 4","key":"b13","series-title":"Neurosurgery","first-page":"S108","article-title":"Minimally invasive spinal surgery in the elderly: does it make sense?","volume":"77","author":"Shamji MF","year":"2015","unstructured":"Shamji MF, Goldstein CL, Wang M, Uribe JS, Fehlings MG. Minimally invasive spinal surgery in the elderly: does it make sense?. Neurosurgery. 2015;77(Suppl 4):S108\u2013S115."},{"issue":"6","key":"b14","series-title":"Anesthesiology","first-page":"1184","article-title":"Brief preoperative screening for frailty and cognitive impairment predicts delirium after spine surgery","volume":"133","author":"Susano MJ","year":"2020","unstructured":"Susano MJ, Grasfield RH, Friese M,  Brief preoperative screening for frailty and cognitive impairment predicts delirium after spine surgery. Anesthesiology. 2020;133(6):1184\u20131191."},{"issue":"Suppl 1","key":"b15","series-title":"J Spine Surg","first-page":"S41","article-title":"The benefit zone of full-endoscopic spine surgery","volume":"5","author":"Hasan S","year":"2019","unstructured":"Hasan S, H\u00e4rtl R, Hofstetter CP. The benefit zone of full-endoscopic spine surgery. J Spine Surg. 2019;5(Suppl 1):S41\u2013S56."},{"issue":"2","key":"b16","series-title":"J Am Coll Surg","first-page":"136","article-title":"American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. Postoperative delirium in older adults: best practice statement from the American Geriatrics Society","volume":"220","year":"2015","unstructured":"American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. Postoperative delirium in older adults: best practice statement from the American Geriatrics Society. J Am Coll Surg. 2015;220(2):136\u2013148.e1."},{"issue":"4","key":"b17","series-title":"Neurosurg Focus","first-page":"E3","article-title":"The safety profile of lumbar spinal surgery in elderly patients 85 years and older","volume":"39","author":"Wang MY","year":"2015","unstructured":"Wang MY, Widi G, Levi AD. The safety profile of lumbar spinal surgery in elderly patients 85 years and older. Neurosurg Focus. 2015;39(4):E3."},{"issue":"6","key":"b18","series-title":"J Spinal Disord Tech","first-page":"324","article-title":"Acute hospital costs after minimally invasive versus open lumbar interbody fusion: data from a US national database with 6106 patients","volume":"25","author":"Wang MY","year":"2012","unstructured":"Wang MY, Lerner J, Lesko J, McGirt MJ. Acute hospital costs after minimally invasive versus open lumbar interbody fusion: data from a US national database with 6106 patients. J Spinal Disord Tech. 2012;25(6):324\u2013328."},{"issue":"6","key":"b19","series-title":"J Neurosurg Spine","first-page":"694","article-title":"An analysis of the differences in the acute hospitalization charges following minimally invasive versus open posterior lumbar interbody fusion","volume":"12","author":"Wang MY","year":"2010","unstructured":"Wang MY, Cummock MD, Yu Y, Trivedi RA. An analysis of the differences in the acute hospitalization charges following minimally invasive versus open posterior lumbar interbody fusion. J Neurosurg Spine. 2010;12(6):694\u2013699."},{"issue":"3","key":"b20","series-title":"Neurosurg Clin N Am","first-page":"419","article-title":"Lateral prepsoas (oblique) approach nuances","volume":"29","author":"DiGiorgio AM","year":"2018","unstructured":"DiGiorgio AM, Edwards CS, Virk MS, Chou D. Lateral prepsoas (oblique) approach nuances. Neurosurg Clin N Am. 2018;29(3):419\u2013426."}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/42\/4\/article-p435.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/42\/4\/article-p435.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/42\/4\/article-p435.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T13:44:35Z","timestamp":1772804675000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/42\/4\/article-p435.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,1]]},"references-count":40,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2024.9.spine2431","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2025,4,1]]}}}