The procedures
Spine surgery treats problems with the bones, discs, joints and nerves of the neck (cervical spine) and lower back (lumbar spine). Common reasons for surgery include pressure on a nerve or the spinal cord from a disc or arthritis, instability, deformity, fractures and, less often, tumours or infection.
- Decompression (such as discectomy or laminectomy) removes what is pressing on a nerve.
- Fusion joins two or more vertebrae together, often with screws, rods or a spacer, to make that part of the spine stable.
- Neck surgery may be done from the front of the neck (anterior) or the back (posterior).
The role of your specialist anaesthetist
I am responsible for your anaesthetic, your safety and your comfort from the moment you arrive until you are settled in recovery. In spine surgery that includes positioning you safely, supporting the nerve monitoring that some operations use, managing blood pressure and blood loss, and planning pain relief that continues after surgery.
Common anaesthetic approaches
Most spine surgery is done under general anaesthesia with a breathing tube. When the surgeon uses nerve monitoring, which checks that the nerves and spinal cord are working during the operation, I usually give total intravenous anaesthesia (TIVA), because anaesthetic gases can interfere with the signals. Some shorter lumbar operations can be done under a spinal anaesthetic in suitable patients. A long-acting injection near the spine, or local anaesthetic placed by the surgeon, may be added for pain relief.
The right choice depends on the operation, how long it will take and your health. Not every option will suit you, and I will explain why I recommend a particular plan.
Preoperative assessment and preparation
I will ask about your general health, any heart or lung conditions, sleep apnoea, and your current pain medications, including any strong pain relievers you take regularly. Knowing about these helps me plan effective pain relief afterwards. Blood thinners and some other medicines need an individual plan; please do not stop any medication unless your anaesthetist, surgeon or prescribing doctor has advised you. See Medications Before Anaesthesia.
For neck surgery, I will also examine how well your neck moves and assess your airway, because this guides how the breathing tube is placed safely.
What happens during the procedure
You will be asleep before you are moved into position. Many spine operations are done with you lying face down (prone) on a specially padded frame. Because you cannot feel or move while asleep, we take great care with your position:
- Your eyes are taped closed and kept free of any pressure. The face is supported on a padded headrest that is checked regularly.
- Pressure points such as the chest, hips, knees, elbows and shoulders are cushioned.
- Your arms and neck are positioned to avoid stretching nerves.
For longer or more complex operations I usually place an arterial line, a fine tube at the wrist that measures blood pressure continuously. Blood loss is monitored closely. Measures to reduce it include careful blood pressure control, medications that help blood clot, and sometimes a cell-saver machine that returns your own blood to you. You are kept warm throughout.
Recovery and pain management
Pain after spine surgery is expected, and planning for it starts before the operation. A combination of regular simple pain relievers, stronger medication when needed, and sometimes patient-controlled analgesia (a button you press to give yourself a measured dose) works well for most people. Getting up and moving early, with help from nursing staff and physiotherapists, is encouraged and helps recovery.
After surgery from the front of the neck, you will be watched closely for swelling, which can occasionally affect breathing. A sore throat and some difficulty swallowing are common for a few days. Please tell the nurses straight away if your breathing feels harder or swallowing becomes more difficult. More general guidance is on Recovery & Aftercare.
Relevant anaesthetic risks and precautions
Common side effects include nausea, sore throat and tiredness. Lying face down for a long time can cause temporary facial swelling and, less commonly, pressure injuries to the skin or nerves. Loss of vision after spine surgery is very rare; it is linked mainly with long operations in the face-down position and large blood loss, and the precautions above are designed to reduce this risk. Other risks such as blood clots, the need for a blood transfusion, and confusion in older people are discussed if they are relevant to you.
Your surgeon will explain the surgical risks. For anaesthetic risks in context, see Anaesthetic Safety & Risks.
Links to additional patient resources
- Preparing for Your Procedure
- Understanding Your Anaesthetic & Informed Consent
- Medications Before Anaesthesia
- Recovery & Aftercare
- Types of anaesthesia, Australian and New Zealand College of Anaesthetists (ANZCA)