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Team conducts first awake spine surgery at OHSU

Approach is less invasive, allows faster recovery; patient calls it a great experience
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Josiah Orina, M.D., associate professor of neurological surgery in the OHSU School of Medicine, left, stands with Kevin Blaine, M.D., assistant professor of anesthesiology in the OHSU School of Medicine, outside OHSU Hospital. The two teamed up to be the first at OHSU to conduct an awake spine surgery. (OHSU/Christine Torres Hicks)
Josiah Orina, M.D., associate professor of neurological surgery in the OHSU School of Medicine, left, stands with Kevin Blaine, M.D., assistant professor of anesthesiology in the OHSU School of Medicine, outside OHSU Hospital. The two teamed up to be the first at OHSU to conduct an awake spine surgery. (OHSU/Christine Torres Hicks)

Marking a milestone in minimally invasive surgery, Oregon Health & Science University has successfully completed its first spine surgery without the use of general anesthesia.

Few people relish the idea of spinal surgery at all — let alone going through it while they’re awake. Yet the first OHSU patient to undergo the procedure while awake says she would recommend it for others.

“It was a great experience,” patient Jasmin Felton said.

Felton spent two hours in an outpatient surgery on Nov. 30, and is now recovering at her Portland-area home while caring for her twin 9-year-old sons.

Felton underwent a minimally invasive microdiscectomy, or surgical removal, of a herniated disc that was impinging on a nerve in her lower back. Rather than being fully anesthetized, the surgical team used local spinal anesthesia.

The procedure involved an incision of about an inch-and-a-half; surgeons used an operative microscope to precisely guide the procedure. Although it’s a relatively common type of surgery, Felton’s case marked the first time it had been done at OHSU with the patient awake and communicating.

Josiah Orina, M.D. (OHSU)
Josiah Orina, M.D. (OHSU)

“It went beautifully,” said surgeon Josiah Orina, M.D., associate professor of neurological surgery in the OHSU School of Medicine.

Kevin Blaine, M.D., F.A.S.A, assistant professor of anesthesiology in the OHSU School of Medicine, collaborated with Orina to plan the anesthetic that he expects will be used for future awake spine procedures in the months and years to come. Blaine said the approach is only possible because advancements in the surgery make powerful anesthesia drugs unnecessary.

Kevin Blaine M.D., M.P.H. (OHSU)
Kevin Blaine M.D., M.P.H. (OHSU)

General anesthesia effectively puts patients into an induced coma, a much more time-consuming process that involves the insertion of a breathing tube, heavier medications and potential complications.

“General anesthesia is probably more anesthesia than you need for an incision that you can cover with a Band-Aid,” Blaine said. “These modern surgical techniques really have advanced that much.”

Orina agreed.

“A lot has changed over the past 20 years,” Orina said. “Technology has improved, and we can accomplish the same surgical goals through smaller incisions. In the past, a surgery like this required bigger incisions, more muscle dissection, and more down time. That’s all changed for the better.”

Inaugural procedure

Felton was a prime candidate for the inaugural procedure. As a healthy and active 44-year-old, her sciatic nerve pain had worsened to the point that it had become difficult to stand up or walk. She saw benefits in staying awake during the procedure when Blaine and Orina raised the possibility with her: No breathing tube, a faster recovery and fewer post-surgical pain medications.

Learn more about OHSU’s innovative neurological procedures in this media kit.

During the procedure, the operating room was bathed in Felton’s choice of mellow, classical music.

As she lay on her front, Felton signaled that she needed to reposition herself to accommodate a slight tweak in her shoulder. It’s the kind of easy adjustment that’s not possible for patients under general anesthesia who sometimes come out of long surgery with muscle aches and joint pains, Blaine said.

Felton said she’s recovering fully at home and expects to be back to her normal exercise routine of yoga, strength training and jogging soon.

She credits the hospital staff for making spinal surgery into a positive experience.

“It was really just their energy,” she said, “Dr. Blaine is really positive, communicative and made sure that I was clear on the process well ahead of time. Dr. Orina came in and said ‘Good morning’ as I was getting checked in — and the whole team was really upbeat, positive and friendly.

“I felt like I was in really good hands.”

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