Abstract The increase in spine surgeries in recent years can be attributed to advancements in diagnostic techniques and surgical expertise, along with a growing aging population. While these procedures are conventionally performed under general anaesthesia due to the need for prone positioning, there is growing interest in neuraxial anaesthesia techniques. Neuraxial anaesthesia offers excellent intraoperative and postoperative analgesia, while avoiding airway manipulation and reducing the need for polypharmacy. This case series evaluates the safety and efficacy of combined segmental thoracic spinal-epidural anaesthesia for lumbar spine surgeries. Eleven patients undergoing lower lumbar spine procedures received landmark-guided thoracic spinal and epidural anaesthesia at the T8–T9 and T7–T8 interspaces respectively in the sitting position. The time to perform the procedure was less than 10 minutes in all the cases. All patients received 10 mg of levobupivacaine and 25 mcg of fentanyl intrathecally at the T8–T9 level. The mean surgical duration was 92 minutes, with an average intraoperative blood loss of approximately 200 mL. Hemodynamic parameters remained stable throughout the procedures. Immediate postoperative neurological assessment, including dorsiflexion of the extensor hallucis longus, was feasible on-table, facilitating early detection of any procedure-related complications. As soon as the surgeon requested, the patient was easily instructed to perform the Valsalva maneuver. Postoperative analgesia was effectively maintained with epidural top-ups of 6 ml of 0.25% bupivacaine and intravenous paracetamol eighth hourly. with no new neurological deficits on follow-up. This case series highlights combined segmental thoracic spinal-epidural anaesthesia as a safe and effective alternative to general anaesthesia, offering stable hemodynamics, superior perioperative analgesia, and rapid recovery in patients undergoing lumbar spine surgeries
Parthasarathy et al. (2026) studied this question.