Vijay Yanamadala, MD, of Hartford (Conn.) Healthcare has leveled up his spine practice over the last five years, especially with refining awake spine surgery.
Dr. Yanamadala said he refined his anesthesia protocols, widened the age range of patients and increased efficiency. He shared why awake spine surgery is well-poised for ASC adoption.
Note: This conversation was lightly edited. Read the full conversation here.
Question: How do you predict awake spine surgery will evolve in 2026 and then in the next five years?
Dr. Vijay Yanamadala: By 2026 I predict we’ll see awake techniques become standard practice for single-level decompressions and minimally invasive fusions at major spine centers. Centers that have been doing this work such as the University of Miami, University of California San Francisco have built a strong evidence base. Now it’s about dissemination to more programs.
In the next 12 months specifically, I expect we’ll see increased adoption in the ambulatory surgery center setting. That’s where the real efficiency gains and patient experience improvements become obvious. When you can perform a lumbar decompression on a 70-year-old with multiple comorbidities and have them home the same day, that changes the calculus entirely.
Looking five years out, several trends will converge. First, improved intraoperative imaging and navigation will make minimally invasive approaches even more accessible, and those pair naturally with awake protocols. Second, we’ll see better real-time neuromonitoring techniques specifically designed for awake patients. The ability to check neurologic function intraoperatively is one of the major advantages, and we’ll get better at leveraging it.
Third, patient demand will drive adoption. Just like in joint replacement, where patients now specifically request regional anesthesia instead of general, spine patients will start asking for awake options. The “why would I want intubation if I don’t need it?” question will become standard.
I also predict we’ll see more robust data on long-term outcomes. The early studies show benefits in complications, length of stay, and immediate recovery. But do awake techniques lead to better functional outcomes at one year, two years, five years? That data is coming.
Finally, I think we’ll see expansion to more complex cases like multilevel decompressions, select two-level fusions and procedures we haven’t traditionally considered. As surgeon comfort increases and protocols improve, the envelope will expand appropriately.
