How to start an awake spine program: Protocol and illustrative cases

Figures

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  Fig. 1. Summary: Anesthesia Protocol.

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  Fig. 2. Patient one, preoperative T2 weighted MRI. Mid-sagittal (left) and L4-L5 axial (right) view showing L4-L5 spondylolisthesis, facet arthropathy, and spinal stenosis at L4-L5.

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  Fig. 3. Patient one, preoperative standing flexion (left) and extension (right) radiographs of the lumbar spine, demonstrating L4 and L5 anterolisthesis with reduction on extension.

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  Fig. 4. Patient one, post-operative radiograph demonstrating reduction of L4–5 spondylolisthesis.

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  Fig. 5. Patient two, preoperative axial T2 weighted MRI showing multi-level spinal stenosis most prominently at the L3-L4 and L4–5 levels.

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  Fig. 6. Patient two, preoperative mid-sagittal T2 weighted MRI.

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  Fig. 7. Patient two, preoperative extension (left) and flexion (right) radiograph showing anterolisthesis of L3 on L4 with no dynamic component and multilevel degenerative disc disease.

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  Fig. 8. A) Horseshoe headrest mounted on a Jackson table. B) Patient positioned on a Jackson table. Credit from (De Biase et al., 2021).