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A First in New England: Spinal Fusion on an Awake Patient

October 15, 2021

Two months after performing the first awake spine surgery at Hartford HealthCare (HHC), neurosurgeon Dr. Vijay Yanamadala became the first in New England to perform a different procedure — spinal fusion — on an awake patient.

Spinal anesthesia and local nerve block helped numb the area of the 82-year-old woman’s spine so he could remedy her chronic, debilitating disability caused by spondylolisthesis, a degenerative condition causing bones in the spine to press against nerves. In doing so, the patient did not need to be intubated.

“Our cutting-edge anesthesiology team – including Drs. Vlad Frenk, Theresa Bowling and David Maduram – were the first in the United States to use an innovative technique combining spinal anesthesia with a nerve block to keep the patient comfortable throughout the procedure,” said Dr. Yanamadala, HHC system medical director of spinal quality and surgical optimization and director of spinal deformity surgery.

Awake surgery, he explained, is an option for any patient who does not want to be completely sedated or who cannot tolerate general anesthesia, which was the case with his first surgery in July. The trend mirrors that in orthopedics where surgeons transitioned from general to spinal anesthesia for total joint replacements.

“I think this is going to be a growing trend in spine surgery, too,” said Dr. Yanamadala, who sees patients at the Ayer Neuroscience Institute Spine Wellness Center in Westport and performs surgery at St. Vincent’s Medical Center in Bridgeport.

Using the revolutionary combination of spinal anesthesia and nerve blocks also enables the patients to use fewer pain medications after surgery, he explained. All of his awake surgery patients to date have gone without opioids entirely and typically go home the same day.

“Since the COVID-19 pandemic began, people more than ever want to go home, so this makes a big difference for them. It’s another trend I think is here to stay,” Dr. Yanamadala said.

Looking ahead, he predicted awake spine surgery will be a popular approach as demand from patients increases and the cost savings appeals to hospitals and insurers.

He attributed such advancements for spine patients at HHC to the skilled team in place, including “pioneering anesthesiologists who champion these innovations,” physician assistants and support staff.

“We are proud to offer these procedures, which have been demonstrated to reduce recovery time, length of stay and narcotic usage,” he said.