Find out why anesthesia for a herniated (bulging) disc has to be general, and why not regional or local?
This is a common question, and a good one at that, since many people are afraid that they “won’t wake up” after being put under.
You’d think that surgery for a herniated or bulging disc can be done under regional anesthesia or even under a nerve block, being that the procedure is non-invasive and relatively simple — when compared to heart, abdominal or brain surgery, and of course, joint replacement surgery.
However, this is not the case, says Dr. P. Justin Tortolani, from MedStar Union Memorial Hospital in Baltimore. Dr. Tortolani is an orthopedic surgeon and spine specialist.
Why General Anesthesia Is Necessary for Surgical Repair of a Herniated Disc
“Since the lumbar spine is where herniated discs occur, one cannot reliably anesthetize the lumbar spine with a lumbar epidural or spinal anesthetic,” says Dr. Tortolani.
“Spinal blocks higher up in the thoracic spine would theoretically be feasible. However, in this region there is much higher risk for cord injury from the anesthetic, and therefore it is not done.
“In addition, we don’t want to take the risk that the patient feels anything that we do, and we certainly don’t want the patient moving during the procedure.”
So why, then, can hip or knee surgery, which are more invasive, complicated and lengthier than herniated disc surgery, be performed under regional anesthesia?
Dr. Tortolani explains, “The hip and knee are much further down the body and therefore can be ‘blocked’ effectively with an agent administered in the lumbar region.”
A patient may want general anesthesia for bulging disc repair but may not qualify for it due to another medical condition such as severe heart disease. For an opposing view by another spinal surgeon, go here.