Our knowledge of orthopaedics. Your best health.

from the American Academy of Orthopaedic Surgeons

Diseases & Conditions



Staying Healthy

Awake Spinal Surgery

Awake spinal surgery, also known as intravenous sedation surgery, is a procedure where the patient remains awake during the operation.

The awake method was developed and has been commonly used in other surgical specialties — such as by neurosurgeons for brain procedures like craniotomy. Its use has now expanded to include spinal procedures, including laminectomy, diskectomy, and minimally invasive surgeries such as transforaminal lumbar interbody fusion. Until recently, these procedures have been performed only under general anesthesia.

Spinal surgery performed with the patient awake can reduce the risks associated with general anesthesia, potentially leading to quicker recovery times and improved results for patients.

Surgical Technique


Usually, when you have surgery, you receive medicine (general anesthesia) that makes you sleep. General anesthesia requires doctors to place a tube through your mouth and down into your throat to help you breathe.

In awake spinal surgery, doctors use a different kind of medicine called spinal anesthesia. This medicine does not put you to sleep. Instead, it numbs the surgical area, so you don't feel pain during the surgery. Spinal anesthesia is considered safer because you don't need a breathing tube, and not having a breathing tube is easier on your heart and lungs.

Surgeons also use pain nerve block techniques alongside spinal anesthesia to enhance patient comfort during surgery.


Once in the operating room, patients undergoing awake spinal surgery can receive a numbing injection. The medicine begins to take effect as soon as it is administered and will last throughout the entire procedure.

During the procedure, the patient will be mildly sedated or sleepy, and their airway will be maintained by an anesthesiologist or anesthesia provider.

The doctor may ask you questions during the procedure, such as if your pain is improving, to make sure the procedure is successful. You may also be asked to move your leg or arm to see if the surgery is addressing the problem while preserving feeling and function.

Advantages and Disadvantages of Awake Spinal Surgery

These are some potential advantages:

  • It can make the surgery quicker.
  • You might not lose as much blood because minimally invasive techniques are used instead of large incisions.
  • You are less likely to feel sick (nauseated, dizzy, etc.) afterward, because spinal anesthesia causes fewer side effects than general anesthesia.
  • You can recover faster and might not have to stay in the hospital as long.
  • The doctors can check with you during the surgery to see how you're doing and make real-time adjustments if needed.
  • It can help you have less post-operative pain because minimally invasive techniques are used instead of large incisions.
  • You do not need a machine to help you breathe during the surgery, so there is less stress on your heart and lungs.

These are some potential disadvantages:

  • Not everyone can have this kind of surgery. You must be able to lie on your stomach without any problems. You also need to be at a healthy weight and not have other health issues, such as lung disease or heart disease.
  • It can make some people feel anxious or scared. The doctors will give you medicine to help you feel better, or they might play music to help you relax.


Depending on the type of surgery performed, you will start moving around with some help from the doctors and nurses immediately after your procedure.

During recovery, before you are discharged from the hospital, the staff will evaluate you for recovery from your spinal anesthesia by making sure your arms and legs are strong and you can feel things as you did before. They will also give you some medicine to help with pain, but you might not need as much pain medicine as you would with other kinds of surgery.

Future Directions

Moving forward, doctors will keep studying awake spinal surgery to investigate long-term results. More large-scale studies are needed to determine which patients directly benefit from awake spinal surgery, to ensure patient safety and provide the best possible outcomes.


Last Reviewed

April 2024

Contributed and/or Updated by

Kyle Geiger, MDReagan Adele Grieser-Yoder, BA, BSCatherine Renee Olinger, MD

Peer-Reviewed by

Thomas Ward Throckmorton, MD, FAAOS

AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.