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Anesthesia for elective spine surgery in adults

Michael J Brown, MD
Section Editor
Jeffrey J Pasternak, MD
Deputy Editor
Marianna Crowley, MD


Surgical procedures on the spine and spinal cord are common and are performed for a wide variety of conditions. They range in complexity from minimally invasive, single-level decompression to highly complex, multi-stage extensive reconstruction. Operative procedures for degenerative spine disease and herniated disks are most common in those under 60 years of age, while those over 60 years of age most commonly undergo spine surgery for spinal stenosis [1].

Anesthesia providers will increasingly care for patients having spine surgery as the population ages and clinical innovation and technological advancement continue. This topic will discuss preoperative evaluation and intraoperative management of adult patients having elective spine surgery. Selection of patients for surgical treatment and options for surgical treatment are discussed to a greater extent in other topics. (See "Lumbar spinal stenosis: Treatment and prognosis", section on 'Surgical treatment' and "Subacute and chronic low back pain: Surgical treatment", section on 'Indications for spinal surgery'.)


Preoperative evaluation should focus on assessment of the airway and the respiratory, cardiovascular, musculoskeletal, and neurologic organ systems.

Airway evaluation – Airway management for patients presenting for spine surgery may be difficult, particularly when surgery on the upper thoracic or cervical spine is planned. These patients may present with diseases that distort airway anatomy or restrict neck or jaw movement, such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, neuromuscular disorders, and previous radiation of the head or neck. In addition, these patients may have instability of the cervical spine, which will affect the choice of intubation technique. (See 'Airway management' below.)

Airway evaluation and management are discussed more fully separately. (See "Airway management for induction of general anesthesia", section on 'Airway assessment'.)

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Literature review current through: Nov 2017. | This topic last updated: Aug 23, 2017.
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