Can Low-Dose Analgesic Spinal Anesthesia Be a Safe and Effective Anesthetic Strategy for Percutaneous Endoscopic Lumbar Discectomy? A Prospective Single-Center Study
Abstract
Francesco Saturno, Giulia Monaco, Angela Salerno, Antonio Cianciola, Nicole Cianciola and Emidio Cianciola
Background: Percutaneous Endoscopic Lumbar Discectomy (PELD) has become an established minimally invasive procedure for lumbar disc herniation. Although general anesthesia is widely used, regional anesthetic techniques may provide advantages by allowing continuous neurological monitoring, minimizing opioid requirements, and facilitating postoperative recovery. However, evidence regarding low-dose analgesic spinal anesthesia during PELD remains limited.
Objective: To evaluate the safety, feasibility, and clinical effectiveness of low-dose analgesic spinal anesthesia in patients undergoing single-level PELD.
Methods: This prospective single-center observational study included 60 consecutive patients undergoing transforaminal PELD between January 2024 and March 2026. Subarachnoid anesthesia consisted of:
• Ropivacaine 6 mg
• Fentanyl 15 μg
Sedation was achieved with midazolam 5 mg intravenously.
Clinical outcomes included:
• operative time
• hospital stay
• intraoperative complications
• postoperative complications
• Visual Analog Scale (VAS)
• Oswestry Disability Index (ODI)
Patients were evaluated preoperatively and at 3, 6, and 12 months after surgery.
Results: Sixty patients completed the 12-month follow-up.
The mean age was 46.8 ± 11.3 years, with 34 men and 26 women.
Disc levels included:
• L3–L4: 16 patients
• L4–L5: 24 patients
• L5–S1: 20 patients
Mean operative time was 50 ± 12 minutes, while the mean hospital stay was 3 ± 0.8 days.
Pain significantly improved from a preoperative VAS score of 7.6 ± 0.8 to 0 at 12 months.
Functional disability improved from an ODI of 28 ± 3.0 to 8.0 ± 4.0.
No conversion to general anesthesia was required.
No major neurological or anesthetic complications occurred.
Conclusions: Low-dose analgesic spinal anesthesia appears to be a safe, feasible, and effective anesthetic strategy for Percutaneous Endoscopic Lumbar Discectomy. Excellent pain control, preservation of neurological monitoring, rapid postoperative recovery, and high patient satisfaction support its use in appropriately selected patients.