Anesthesia Consideration for Posterior Stabilization Surgery

Spinal surgery is often performed to address symptomatic compression of nerve roots or the spinal cord due to trauma or degenerative disorders. Posterior stabilization procedures present unique anesthetic challenges, particularly with the prone position commonly employed. General anesthesia remains the standard for lumbar spine surgery, although spinal anesthesia offers advantages for high-risk patients, such as reduced blood loss and fewer pulmonary complications. This review outlines the critical anesthetic considerations across preoperative, intraoperative, and postoperative phases for posterior stabilization surgery. Preoperative evaluation includes assessments of airway, pulmonary and cardiovascular function, musculoskeletal and neuromuscular systems, laboratory testing, and potential autologous blood donation. Intraoperative management focuses on minimizing blood loss and maintaining hemodynamic stability, often incorporating blood conservation strategies like tranexamic acid. Pain management employs multimodal approaches to address severe postoperative pain, while complications from prone positioning, such as nerve injuries and hemodynamic instability, require vigilance. Postoperative outcomes are influenced by complications, including neurological, cardiopulmonary, and structural issues, underscoring the importance of meticulous anesthetic planning and management throughout the perioperative period. This review highlights best practices and strategies to enhance safety and efficacy in posterior stabilization surgery.