Neurosurgeon completes “awake” spinal fusion surgery, a first in Colorado |

Neurosurgeon completes “awake” spinal fusion surgery, a first in Colorado

Dr. Ernest Braxton, of Vail-Summit Orthopaedics & Neurosurgery, said benefits include a faster recovery time and a decreased need for postoperative narcotics

By Lauren Glendenning Brought to you by Vail-Summit Orthopaedics & Neurosurgery
An “awake” surgery offers the following benefits for the patient:
  • The surgeon can monitor the patient neurologically throughout the procedure.
  • The procedure eliminates the need for costly intra-operative neurological monitoring.
  • The awake patient can help the surgeon to locate pathology.
  • There is less risk of the patient undergoing neuropraxia (nerve injury) from positioning during surgery.
  • There are less risks of complications from anesthesia, especially at altitude.
Source: Vail-Summit Orthopaedics and Neurosurgery For more about minimally invasive spine surgery and Dr. Ernest Braxton, visit or

Board Certified Neurosurgeon Dr. Ernest Braxton completed a two-hour spinal surgery — during which the patient remained awake, alert, comfortable and able to watch a video on an iPad — in Vail earlier this month. 

This minimally-invasive surgery, called an Awake MIS TLIF (transforaminal lumbar interbody fusion), was the first of its kind performed in Vail. Keeping the patient awake, treated with localized pain blocks, avoids the need for general anesthesia and after-surgery narcotics. It allows Dr. Braxton to examine the patient’s neurological condition during the procedure, which makes the operation safer. It also eliminates the need to use intravenous narcotics and decreases the overall cost of the hospital stay.

“It allows me to locate what the pain generator is in real-time and fix it, and it ensures that the neurological structures are handled with great care during the surgery,” Dr. Braxton, of Vail-Summit Orthopaedics and Neurosurgery, said. “It also facilitates a more professional environment in the operating room that is centered on taking care of the patient and respect for the patient.”

What is a transforaminal lumbar interbody fusion?

The transforaminal lumbar interbody fusion procedure is a surgery designed to fuse two segments of bone together. The reasons for doing this can be to correct a deformity of the spine or to treat spinal instability, Dr. Braxton said. 

Patients that need a spine fusion generally have not responded to conservative therapies such as physical therapy or back injections. They often have spinal instability from arthritic joints or from a fracture in the spine. Most of these patients are suffering with chronic back pain and/or leg pain.

Benefits of remaining “awake”

While this operation is commonly done with a general anesthetic, Dr. Braxton said this is the first case in Vail done without general anesthesia, thus keeping the patient “awake.”

“This procedure utilizes pain blocks and local anesthesia rather than putting the patient to sleep and securing their airway with a breathing tube. It allows me to monitor the patient’s neurological condition in real-time, reduces postoperative narcotics, and eliminates the need for IV narcotics” he said. 

Traditionally, patients stay in the hospital for three to four days after this type of surgery. Dr. Braxton said the awake surgery allows the patient to leave the hospital the same day or the next day. 

Quicker recovery time

Dr. Braxton thinks there will be a real demand for this type of surgery in the mountains due to the speedier recovery time.

“I think those are the types of results that our active population here in Vail and Summit County are looking for, and I am going to continue to bring new techniques to the Valley that will help our patients achieve their goals,” he said.

Patients with back problems tend to be a vulnerable population at risk for narcotic addiction, Dr. Braxton added, which is another reason why eliminating or reducing the postoperative narcotics required for this minimally invasive procedure is significant. 

“Currently, awake spine surgery is a growing trend among minimally invasive spine surgeons, but was only available in major medical centers on the East or West coast,” he said.

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