Dr. Ernest Braxton, a neurosurgeon at Vail-Summit Orthopaedics & Neurosurgery, introduced a breakthrough procedure at Vail Health by completing a successful spine surgery with his patient awake.
The surgery, a transforaminal lumbar interbody fusion, took approximately two hours, during which the patient was awake, alert, comfortable and able to watch video on an iPad. This new minimally invasive technique should lead to quicker recovery times and offer several additional benefits to the patient.
“I’m excited to introduce this new procedure to Eagle County,” Braxton said in a Vail Health release. “This is the first of its kind in Vail, and to my knowledge, the first of its kind in Colorado.”
Dr. Braxton performed awake spine surgeries in Texas before moving to Vail in 2017. He says awake spine surgery is a growing trend among minimally invasive spine surgeons but is currently only available in major medical centers on the East or West Coast.
During an awake surgery, the patient is treated with localized pain blocks, avoiding the need for general anesthesia and after-surgery pain narcotics. An expert in minimally invasive spine surgery, Dr. Braxton says by removing the need for anesthesia, certain risks presented by traditional methods are eliminated, which is especially pertinent at higher altitudes.
Dr. Braxton adds that patients with back problems tend to be a vulnerable population who are at risk for narcotic addiction.
“So, eliminating or reducing the postoperative narcotics required for this minimally invasive procedure is significant.”
The awake surgery also allows a spine surgeon to examine patients in real time during the procedure. Dr. David Ruttum was the administering anesthesiologist during the procedure and said doing an awake spine surgery is revolutionary.
“Up until now, we’ve had to use physiological measures such as using a patient’s heartbeat and blood pressure to know whether the patient was having a problem or experiencing pain during surgery,” Ruttum said. “Now I can ask the patient and get an immediate answer. This is particularly helpful with a spine surgery when the awake patient can help the surgeon locate the pain generator.”
Dr. Braxton said an awake patient must have the right temperament.
“Some people have a fear of being awake. But you undergo a certain vulnerability when you’re asleep, so a lot of folks like being awake during surgery; it gives them a greater awareness. It also facilitates a more professional environment in the operating room that is centered on taking care of the patient.”
Not only does an awake surgery result in faster recoveries and less narcotics, it is more cost effective since it eliminates the need for costly intraoperative neurological monitoring and lengthy hospital stays. Dr. Braxton said, in the Vail Health release, that he expects to conduct about 50 minimally invasive awake spine surgeries per year.
“I want my patients to be out there being active sooner, instead of spending three to four days in the hospital. I think those are the types of results that our active population here in Eagle and Summit County are looking for.”
Dr. Braxton performed another first-of-its-kind surgery in the United States late last year, completing a trans-umbilical (belly button) implantation of lumbar artificial disc, which allows the patient to heal without any scarring on the belly.
“Dr. Braxton is an excellent neurosurgeon and we are grateful for the innovation and expertise he and his team bring to Eagle County,” said Vail Health President and CEO Will Cook in the hospital’s release. “It’s not common to see such trailblazing work being done in a small, rural hospital like ours, but Vail is a destination for skilled physicians with a passion for getting people back to their active lifestyles.”