Shifting Paradigms: A Nationwide Survey of Anesthesiologists’ Perspective on Spinal Anesthesia for Lumbar Spine Surgery

Introduction: Despite ample evidence of safety, the adoption of spinal anesthesia in lumbar spine surgery is limited. We aimed to assess anesthesiologists’ perspective on its use, and address barriers that limit adoption.

Methods: A survey was distributed via REDCap to members of the American Society of Anesthesiologists. Expertise in anesthesia, practice setting, and subspecialty were recorded. Experience with administering spinal and its feasibility were elicited. Analysis employed Pearson’s Chi-Square Test in Stata.

Results: Of the 516 total respondents, 49% report 20 + years of experience, 31.4% with 11-20, and 19.6% with 1-10. Practices included teaching hospitals (36.6%), community health (27.7%), and private (25.6%). Overall, 21% reported utilization of spinal anesthesia – of which 16% were anesthesiologists with 1-10 years of experience, 16% with 11-20, and 26% with 20 + (P=0.012). A total of 19% have never heard of spinal anesthesia being used for spine surgery – of which 32% report 1-10 experience years versus 19% with 11-20, and 13% with 20 + (P < 0.001). Greater clinical experience, prior exposure, and interest level predicted feasibility perceptions for lumbar surgery (P < 0.005). Airway management in the prone position and surgery duration variability were the most reported concerns. Less experienced anesthesiologists cited knowledge gaps and medicolegal concerns.

Conclusion : Spinal anesthesia in lumbar spine surgery is infrequently utilized, particularly by less experienced anesthesiologists. Less experienced anesthesiologists express an interest in learning, while experienced anesthesiologists are receptive to adoption. This represents an opportunity for experienced anesthesiologists to lead educational efforts to the younger generation.