Spinal Anesthesia and Digital Anxiolysis (SPIDA) for the treatment of lumbar spinal stenosis - a feasibility study.

Abstract

Lumbar spinal stenosis (LSS) is a prevalent condition, particularly in elderly patients, characterized by a clinical syndrome that includes buttock or lower extremity pain, commonly associated with sensory and motor dysfunction. The surgical management of these patients is challenging due to higher rates of comorbidities and increased risks of experiencing complications such as postoperative delirium, leading to intensive care and prolonged hospital stays. Awake surgery under spinal anaesthesia (SA) has been associated with advantages concerning the occurrence of complications and the clinical outcome after surgery. Within this study, we aim to investigate the combination of spinal anesthesia without administration of any systematically effective medication and digital anxiolysis for patients suffering from one-level lumbar spinal stenosis who were treated via microsurgical decompression. This is a single-centre feasibility study. We included patients with LSS that were treated via microsurgical decompression. The patients were divided into groups according to the anaesthetic technique employed: (a) classical GA-Group or (b) Spinal Anaesthesia and Digital Anxiolysis via Virtual Reality Goggles (SPIDA-Group). Demographic, clinical, and radiographic patient data were retrospectively extracted from clinical records and documentation. For SPIDA-Group patients Odom's criteria (excellent/good/fair/poor) were additionally routinely assessed. Matched pair analysis was performed to compare the outcomes of both groups. The final study population consisted of 65 patients. The surgical and clinical outcomes between GA-Group and SPIDA-Group were equivalent. 86.7% of the SPIDA-Group patients described their surgical experience as excellent, and 13.3% described it as good. All patients treated with the SPIDA-Bundle indicated that they would undergo the surgery again in the SPIDA setting. In 2 patients, the lumbar puncture was unsuccessful (punctio sicca), leading to the switch to GA. One patient reported an inadequate sensitive distribution of the spinal anesthetic, necessitating a switch to GA as well. Furthermore, in one patient, the intrathecal application caused a dural leak. This had to be surgically closed with sutures during the surgery. None of the patients suffered postoperative delirium. The combination of digital anxiolysis and spinal anesthesia is a feasible and promising approach for the microsurgical treatment of LSS. Patients report compelling satisfaction, and clinical outcomes are comparable to GA.