Corresponding Author

David A.W. Sykes

Subject Area

Degenerative, Lumbosacral spine

Document Type



Background Data: Awake spine surgery has been an area of increasing interest, but it is still relatively uncommon.

Purpose: The article aims to review the existing literature to summarize practices, outcomes, and trends in awake spine surgery to determine if awake spine surgery is merely a fad or the future of spine surgery.

Study Design: A narrative literature review.

Patients and Methods: The authors performed primary and secondary searches of the PubMed database to reveal works relevant to awake spine surgery. These results, in addition to works known to the authorship, were subjectively selected for inclusion in the narrative review based on relevance to the authors’ aims.

Results and Discussion: Many types of spine surgery, from the lumbosacral to the cervical spine, can be performed in the awake patient. Anesthetic methods are varied and include, but are not limited to, spinal anesthesia, epidural anesthesia, and truncal blocks. These techniques may be used in isolation or combined. Patients that are ideal candidates for spine surgery have been well described, including patients receiving 1-2 level decompressions or fusion. Older patients may be good candidates for awake surgery. The outcomes associated with awake surgery are promising and seem superior to those associated with general anesthesia. There are multiple published protocols and instructions on selecting patients for and safely performing awake spine surgery. The incidence of awake spine surgery is increasing.

Conclusion: Awake spine surgery is more than a fad and may be the future of spine surgery.


awake spine surgery, spinal anesthesia, regional anesthesia, minimally invasive surgery, elderly