Faster recovery, fewer risks with spinal surgery under conscious sedation

James Ewing wasn’t surprised when, in his mid-60s, he began to feel chronic pain in his lower back. He had hurdled his way into the 1976 Olympic trials, played basketball throughout his 40s and ran 10-mile treks for years. 

“I’ve always been very active, and I knew there was a lot of wear and tear,” the 68-year-old Modesto, California, resident said. 

At first, painful flare-ups would improve after about a week. But, he said, “Every time I tweaked it, it took longer to recover. It got to the point where it wasn’t going away. I had to walk hunched over. Everything I did was to accommodate the constant pain.”

Narrowing of spinal canal

Ewing learned last year from his physicians in Modesto that he had lumbar spinal stenosis, in which the spinal canal narrows, compressing nerves. For relief, surgery is required to widen the canal.

Ewing’s primary care doctor recommended Stanford Medicine. Ewing visited Todd Alamin, MD, professor of orthopaedic surgery.

Alamin felt that a minimally invasive micro-decompression would address Ewing’s symptoms. He gave him a choice: During the procedure, Ewing could undergo general anesthesia, or he could have local anesthesia with conscious sedation. 

The latter option, also known as twilight sedation, is commonly used in dental procedures and colonoscopies, but not in spinal surgery. Patients respond to conscious sedation in various ways: Some are essentially asleep, while others have a foggy awareness; still others are wide awake. Alamin says he doesn’t know of anyone else using it in spinal decompressions.

He offers it to patients of all ages, but he especially recommends it to patients who are 80 or older because it may help them avoid cognitive problems from a condition called postoperative cognitive dysfunction, which can last a year or more. 

'It leads to gentler surgery'

Another benefit of conscious sedation is that patients recover more quickly; they can often leave an hour after surgery. Also, a patient will react if Alamin’s surgical tools compress a nerve  — their heart rate may increase, they may move a little or they may even speak — warning him to steer clear. “I get immediate feedback,” Alamin said. 

While surgery under conscious sedation requires Alamin to work more delicately to avoid causing the patient any discomfort, he said that’s a benefit: “It leads to gentler surgery and likely a lower risk of scarring and nerve injury.” 

Ewing chose the conscious sedation. The Dec. 12 procedure took an hour, and he headed home to Modesto the same day. 

Ewing said that he remembers nothing from the operation, but that he felt better immediately. “I can stand up straight. I can sleep at night,” he said. “Things I take for granted now I couldn’t do before.”

The retired Disneyland executive plans to stay active through low-impact activities, such as swimming, walking his dog and hiking with his camera. “I’m looking forward to getting in the pool and doing a lot of laps,” Ewing said.