Type of anesthesia for lumbar spine surgery in prone position

Mykola Lyzohub, Igor Kotulskiy, Kseniia Lyzohub, Natalya Moskalenko, Victoriia Pishchik


Lumbar spine surgery may be performed under general or spinal anesthesia. There are no criteria for choosing of anesthesia type for such surgery. Objective: to justify the tepe of anesthesia for lumbar spine surgery in prone position. Methods: 254 patients with degenerative lumbar spine diseases ASA I–II were prospectively enrolled to the study. Patients of the spinal anesthesia group (n = 144) were operated under spinal anesthesia, patients of the TIVA group were operated under total intravenous anesthesia. We evaluated the hemodynamics, blood loss, intraocular pressure (IOP) in supine position before and immediately after surgery. Control group was formed by healthy volunteers in whom intraocular pressure was measured before and immediately after lying in the prone position during 90 minutes. Results: turning of non-anesthetized patients into prone position led to decreasing of stoke volume by 25.5 %. We compared these data with intraoperative requirements for sympathomimetics and we could work out the prognostic index of hemodynamic instability (PIHI). In patients with PIHI ≥ 0.5 the risk of intraoperative hemodynamic instability under spinal anesthesia was high. Blood loss in patients with controlled hypotension (mean blood pressure 60–80 mm Hg) did not differ between the groups. Surgery time was significantly higher in TIVA group. Intraocular pressure in prone position was higher, than in supine position. The most significantly IOP increased in TIVA patients on the turned head side. IOP in SA patients did not differ from healthy volunteers. Conclusions: before surgery in prone position it is helpful to evaluate hemodynamic reactions for the body position changes. In cases of PIHI ≥ 0.5 it is better to choose general anesthesia. Type of anesthesia does not influence on the blood loss if controlled hypotension is used. IOP increases significantly in prone position under TIVA.


spine surgery; anesthesia; hemodynamics; blood loss; intraocular pressure


Martin, B. I., Mirza, S. K., Spina, N., Spiker, W. R., Lawrence, B., & Brodke, D. S. (2019). Trends in Lumbar Fusion Procedure Rates and Associated Hospital Costs for Degenerative Spinal Diseases in the United States, 2004 to 2015. SPINE, 44 (5), 369–376. doi: 10.1097/brs.0000000000002822

Attari, M., Mirhosseini, S., & A. Honarmand, M. (2011). Safavic Spinal anesthesia versus general anesthesia for elective lumbar spine surgery: A randomized clinical trial. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 16 (4), 524–529.

Finsterwald, M., Muster, M., Farshad, M., Saporito, A., Brada, M., & Aguirre, J. A. (2018). Spinal versus general anesthesia for lumbar spine surgery in high risk patients: Perioperative hemodynamic stability, complications and costs. Journal of Clinical Anesthesia, 46, 3–7. doi: 10.1016/j.jclinane.2018.01.004

Hollman, F., Wolterbeek, N., & Veen, R. (2015). Risk Factors for Postoperative Urinary Retention in Men Undergoing Total Hip Arthroplasty. Orthopedics, 38 (6), e507–e511. doi: 10.3928/01477447-20150603-59

Kamel, I. (2014). Positioning patients for spine surgery: Avoiding uncommon position-related complications. World Journal of Orthopedics, 5 (4), 425. doi: 10.5312/wjo.v5.i4.425

Lizogub, M. V., Georgiants, M. A., Vysotska, O. V., Porvan, A. P., & Lizogub, K. I. (2009). A method for predicting adverse changes in hemodynamics on the background of spinal anesthesia. Patent 131991 UA.

Zorrilla-Vaca, A., Healy, R. J., & Mirski, M. A. (2017). A Comparison of Regional Versus General Anesthesia for Lumbar Spine Surgery. Journal of Neurosurgical Anesthesiology, 29 (4), 415–425. doi: 10.1097/ana.0000000000000362

Meng, T., Zhong, Z., & Meng, L. (2016). Impact of spinal anaesthesia vs. general anaesthesia on peri-operative outcome in lumbar spine surgery: a systematic review and meta-analysis of randomised, controlled trials. Anaesthesia, 72 (3), 391–401. doi: 10.1111/anae.13702

Pınar, H. U., Kaşdoğan, Z. E., Başaran, B., Çöven, İ., Karaca, Ö., & Doğan, R. (2018). The effect of spinal versus general anesthesia on intraocular pressure in lumbar disc surgery in the prone position: A randomized, controlled clinical trial. Journal of Clinical Anesthesia, 46, 54–58. doi: 10.1016/j.jclinane.2018.01.026

Copyright (c) 2020 Mykola Lyzohub, Igor Kotulskiy, Kseniia Lyzohub, Natalya Moskalenko, Victoriia Pishchik

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.