{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T05:04:24Z","timestamp":1789621464974,"version":"build-2803163510"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T00:00:00Z","timestamp":1712793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Spinal anesthesia (SA) is a good alternative to general anesthesia (GA) for spine surgery. Despite that, a few case series concern the use of thoracic spinal anesthesia for short-duration surgical interventions. In search of an alternative approach to GA and a better opioid-free modality, we aimed to investigate the safety, feasibility, and patient satisfaction of thoracic SA for spine surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>We analyzed retrospectively a cohort of 24 patients operated on for a degenerative and osteoporotic pathology of the lower thoracic and lumbar spine. Data was collected from medical records, including clinical notes, operative and anesthesia records, and patient questionnaires.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty-one surgeries for herniated discs, two for degenerative spinal stenosis, and one for multi-level osteoporotic vertebral body fractures were performed under spinal anesthesia with intrathecal sedation. In all cases, we applied 0.5% isobaric bupivacaine and the following adjuvants: midazolam, clonidine or dexmedetomidine, and dexamethasone. We boosted the anesthesia with local ropivacaine due to inefficient sensory block in two patients. Nobody in the cohort received intravenous opioids, non-steroidal anti-inflammatory drugs, or additional sedation intraoperatively. Postoperative painkillers were upon the patient\u2019s request. No significant complications were detected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Thoracic spinal anesthesia incorporating adjuvants such as midazolam, clonidine or dexmedetomidine, and dexamethasone demonstrates not only efficient conditions for spine surgery, a favorable safety profile, high patient satisfaction, and intrathecal sedation but also effective opioid-free pain management.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2024.1387935","type":"journal-article","created":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T05:01:11Z","timestamp":1712811671000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Thoracic spinal anesthesia with intrathecal sedation for lower back surgery: a retrospective cohort study"],"prefix":"10.3389","volume":"11","author":[{"given":"Nikolay","family":"Boykov","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilyan","family":"Ferdinandov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"Vasileva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimo","family":"Yankov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Burev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rositsa","family":"Tanova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,4,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e91","DOI":"10.1016\/j.wneu.2023.05.001","article-title":"Awake spinal fusion is associated with reduced length of stay, opioid use, and time to ambulation compared to general anesthesia: a matched cohort study","volume":"176","author":"Sykes","year":"2023","journal-title":"World Neurosurg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.jclinane.2018.01.004","article-title":"Spinal versus general anesthesia for lumbar spine surgery in high risk patients: perioperative hemodynamic stability, complications and costs","volume":"46","author":"Finsterwald","year":"2018","journal-title":"J Clin Anesth"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"E6","DOI":"10.3171\/2021.9.FOCUS21456","article-title":"Spine surgery under awake spinal anesthesia: an Egyptian experience during the COVID-19 pandemic","volume":"51","author":"Khattab","year":"2021","journal-title":"Neurosurg Focus"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"713","DOI":"10.14444\/7103","article-title":"Spinal anesthesia for geriatric lumbar spine surgery: a comparative case series","volume":"14","author":"Lessing","year":"2020","journal-title":"Int J Spine Surg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1016\/j.jcot.2020.11.017","article-title":"Comparative outcome analysis of spinal anesthesia versus general anesthesia in lumbar fusion surgery","volume":"13","author":"Sekerak","year":"2021","journal-title":"J Clin Orthop Trauma"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1097\/AAP.0b013e3181c75c05","article-title":"Spinal anesthesia and intrathecal clonidine decrease the hypnotic requirement of Propofol","volume":"35","author":"Jang","year":"2010","journal-title":"Reg Anesth Pain Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"23","DOI":"10.2147\/LRA.S358157","article-title":"Opioid-free segmental thoracic spinal anesthesia with intrathecal sedation for breast and axillary surgery: report of four cases","volume":"15","author":"Vincenzi","year":"2022","journal-title":"Local Reg Anesth"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1620\/tjem.207.239","article-title":"Spinal anesthesia in a patient with severe thoracolumbar kyphoscoliosis","volume":"207","author":"Ozyurt","year":"2005","journal-title":"Tohoku J Exp Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1136\/bmjmilitary-2022-002075","article-title":"Thoracic spinal anaesthesia for abdominal surgery in a humanitarian military field hospital: a prospective observational study","volume":"170","author":"Aissaoui","year":"2024","journal-title":"BMJ Mil Health"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1136\/bmj.2.5920.656","article-title":"Controlled sedation with alphaxalone-alphadolone","volume":"2","author":"Ramsay","year":"1974","journal-title":"Br Med J"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1016\/S0952-8180(98)00112-3","article-title":"Spinal anesthesia for elective lumbar spine surgery","volume":"10","author":"Tetzlaff","year":"1998","journal-title":"J Clin Anesth"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"91","DOI":"10.2147\/LRA.S141233","article-title":"Efficiency of spinal anesthesia versus general anesthesia for lumbar spinal surgery: a retrospective analysis of 544 patients","volume":"10","author":"Pierce","year":"2017","journal-title":"Local Reg Anesth."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1016\/j.jcot.2021.04.026","article-title":"Lumbar spine instrumented fusion surgery under spinal anaesthesia versus general anaesthesia-a retrospective study of 239 cases","volume":"18","author":"Sarkar","year":"2021","journal-title":"J Clin Orthop Trauma."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1452","DOI":"10.1097\/00007632-199807010-00005","article-title":"The variation of position of the conus medullaris in an adult population. A magnetic resonance imaging study","volume":"23","author":"Saifuddin","year":"1998","journal-title":"Spine"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5603\/AIT.2013.0001","article-title":"Anatomical landmarks based assessment of intravertebral space level for lumbar puncture is misleading in more than 30%","volume":"45","author":"Duniec","year":"2013","journal-title":"Anaesthesiol Intensive Ther"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.pjnns.2014.05.005","article-title":"Perioperative outcome and cost-effectiveness of spinal versus general anesthesia for lumbar spine surgery","volume":"48","author":"Kahveci","year":"2014","journal-title":"Neurol Neurochir Pol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1136\/rapm-2023-104415","article-title":"Comparison of remimazolam and dexmedetomidine for intraoperative sedation in patients undergoing lower extremity surgery under spinal anesthesia: a randomized clinical trial","volume":"49","author":"Kim","year":"2024","journal-title":"Reg Anesth Pain Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1097\/ANA.0000000000000488","article-title":"Patient, surgeon, and anesthesiologist satisfaction: who has the priority?","volume":"30","author":"Zorrilla-Vaca","year":"2018","journal-title":"J Neurosurg Anesthesiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1007\/s12325-019-01171-6","article-title":"Factors determining the choice of spinal versus general anesthesia in patients undergoing ambulatory surgery: results of a multicenter observational study","volume":"37","author":"Capdevila","year":"2020","journal-title":"Adv Ther"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.surneu.2008.08.003","article-title":"A prospective randomized trial comparing the technique of spinal and general anesthesia for lumbar disk surgery: a study of 100 cases","volume":"71","author":"Sadrolsadat","year":"2009","journal-title":"Surg Neurol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3171\/spi.2005.2.1.0017","article-title":"Comparison of spinal and general anesthesia in lumbar laminectomy surgery: a case-controlled analysis of 400 patients","volume":"2","author":"McLain","year":"2005","journal-title":"J Neurosurg Spine"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1016\/j.jopan.2023.04.003","article-title":"Multimodal analgesia and opioid-free anesthesia in spinal surgery: a literature review","volume":"38","author":"Taylor","year":"2023","journal-title":"J Perianesthesia Nurs Off J Am Soc PeriAnesthesia Nurses"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1387935\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T05:01:14Z","timestamp":1712811674000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1387935\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,11]]},"references-count":22,"alternative-id":["10.3389\/fmed.2024.1387935"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2024.1387935","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,11]]},"article-number":"1387935"}}