74-Year-Old Undergoes Rare “Awake” Spine Surgery in Israel

David Avital is a 74-year-old resident of Israel whose recent tumble left him in need of emergency surgery for a fractured spine. But his previously existing heart and lung conditions meant that undergoing traditional back surgery would leave him extremely vulnerable to potentially fatal complications in the midst of the surgery. Fortunately, Avital had access to Jerusalem’s Hadassah University Medical Center, a state-of-the-art acute care center capable of performing a unique version of spine surgery performed while he was completely awake.

The emergency spine surgery that Mr. Avital needed would normally involve him being put under general anesthesia and being positioned on his stomach to provide surgeons with access to his spine. His pre-existing heart and lung conditions made this a dangerous proposition, so instead the surgical team opted for something that was once thought to be impossible: He was given local anesthesia and the surgery was performed while he was fully awake.

Speaking of the reasons for pursuing this unique method of surgery, r. Josh Schroeder of the Hadassah team explained, “Fracture is a common fall injury in adults that sometimes causes them instability or uncontrollable pain, and they need surgery to recover – and the recovery and rehabilitation process is much more difficult after these surgeries. On the other hand, we know that the danger of general anesthesia in adults increases due to background diseases from which they suffer.” His colleague, Prof. Jose Cohen, director of the Endovascular Neurosurgery Unit agreed, saying, “This case demonstrates a modern approach to surgery. Thanks to a multidisciplinary team and advanced equipment, we at Hadassah are able to bring the most advanced [techniques of] medicine in the world.”

While Hadassah is the only hospital in Israel that offers this type of surgery, it is becoming increasingly accessible around the world, including at the University of California San Francisco.

An article that appeared on the UCSF website a year ago described the “awake spine surgery” that surgeons there had been offering since the spring of 2018. By using a long-acting local anesthetic called liposomal bupivacaine injected directly into the muscle in the lower back prior to the start of the surgery, surgery times were cut in half and pain relief provided for as long as 72 hours.

When complex surgeries such as spinal fusion surgeries are performed using traditional methods, patients generally stay in the hospital for three to four days and are treated with IV painkillers. The patients who are eligible for/require awake surgery have been able to leave the hospital within 24 hours and go home with nothing but oral pain medication.  Perhaps most important of all, patients who are vulnerable to surgical complications are able to avoid the need for a ventilator or breathing tube.

The techniques available for the relief of lower back pain are progressing rapidly. If you have been experiencing pain and would like to learn about the remedies that we can provide at our lumbar spine practice in New Jersey, contact us today to set up an appointment.

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