Why You Might Consider Staying Awake During Spine Surgery

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For many individuals, hearing “you need spinal surgery” may conjure up fear. Fear of general anesthesia. Fear of requiring opioids to manage pain. Fear of a long post-operative recovery and hospital stay. During Patient Safety Awareness Week, DePuy Synthes is highlighting a minimally invasive alternative for eligible patients that is often referred to as “awake” surgery.

During awake spine surgery the patients are conscious and responsive in the operating room throughout the procedure. In some cases, a non-opioid analgesic is infiltrated into the paraspinal musculature, fascia, subcutaneous tissue and skin.  In others a spinal anesthetic may also be administered for intraop and postop pain control.

Avoiding general anesthesia reduces the potential for negative effects, especially in higher risk older patients (60+ years of age).

Michael Wang, MD, a renowned spine surgeon at the University of Miami Health System, and Praveen Mummaneni, MD, Co-Director of the University of California San Francisco (UCSF) Spine Center, and Vice Chair of the UCSF Department of Neurosurgery both offer the awake procedure. They’ve noted several key benefits of the surgical option, including the potential to receive verbal feedback from patients when decompressing the nerve. This increases their confidence that the surgical procedure has successfully addressed the patient’s pain while also reducing incidence of temporary nerve injury due to over-retraction. Other benefits that Dr. Wang and Dr. Mummaneni have experienced include less time in the OR, reduced blood loss when performing minimally invasive spine procedures (MIS), hospital discharges usually within 24 hours compared with 3 to 4 days for open surgery, and reducing or eliminating opioids to manage postsurgical pain. Both doctors agree that the quicker the patient is up and out of the hospital, the less potential there is for complications. 

DePuy Synthes is able to provide minimally invasive implant and instrument options to surgeons who perform awake procedures. These options include the UNLEASH™ Procedural Solution, which incorporates the VIPER PRIME® Fixation System, the CONCORDE LIFT® Expandable Interbody Device, and the CONCORDE® Clear MIS Discectomy Device. Additionally, DePuy Synthes is currently involved in an alliance with Pacira Pharmaceuticals, Inc., to provide EXPAREL® (bupivacaine liposome injectable suspension), a long-lasting local anesthetic, which enables surgeons to provide a non-opioid option for postsurgical pain control.



concorde clear 


Concorde® Clear MIS discectomy device



viper prime


Viper Prime™ fixation system


CONCORDE Lift Expandable Cage 

Concorde Lift™ expandable interbody device

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REVISED_eye level head on 10ml_110618KP

EXPAREL® (bupivacaine liposome injectable suspension)

The Surgeon’s Perspective

Dr. Wang is a pioneer in advancing the use of awake surgery for lumbar fusions and other spinal procedures. He’s been offering minimally invasive awake surgery as an option to patients since 2014 and has performed nearly 200 of these surgeries. By his estimate, ninety percent of his eligible patients choose the awake option once they understand what it is and the potential benefits it offers.

“Patients are afraid of spine surgery, so this is all about changing the experience by reducing the pain, disability, blood loss, and anxiety of undergoing a spinal operation in many cases.” said Dr. Wang. “Most awake patients are now discharged within 24 hours of surgery- many the same day. It’s a very compelling argument as days in a hospital are a surrogate measure of pain, and immobility.”

Dr. Mummaneni traveled to Miami to learn the technique by observing Dr. Wang. Dr. Mummaneni now offers the approach to patients on the West Coast, many seeking him out specifically because he offers awake surgery and for its potential benefits.

“Since I’ve begun offering awake surgery for spinal surgery, patients have been seeking me out for this option,” said Dr. Mummaneni. “Patients are able to get themselves comfortable on the operating table before we begin surgery and they can speak with me and the team if needed. We offer music as an alternative for those patients who may want an audible distraction during the procedure.”                                                   

Patient Important Safety Information (ISI)
EXPAREL® (bupivacaine liposome injectable suspension) should not be used in obstetrical paracervical block anesthesia.
In studies where EXPAREL was injected into the wound, the most common side effects were nausea, constipation, and vomiting.
In studies where EXPAREL was injected near a nerve, the most common side effects were nausea, fever, and constipation.
EXPAREL is not recommended to be used in patients younger than 18 years old or in pregnant women.
Tell your healthcare provider if you have liver disease, since this may affect how the active ingredient (bupivacaine) in EXPAREL is eliminated from your body.
EXPAREL should not be injected into the spine, joints, or veins.
The active ingredient in EXPAREL can affect your nervous system and your cardiovascular system; may cause an allergic reaction; may cause damage if injected into your joints; and can cause a rare blood disorder.

Full Prescribing Information is available at www.EXPAREL.com.

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