For decades, the idea of awake spine surgery would have sounded like science fiction. But at Singapore General Hospital, it is becoming routine — and it may be changing how doctors think about safety in the operating room.
Since 2024, surgeons at Singapore General Hospital have performed more than 200 spine surgeries with patients fully awake. Instead of being put to sleep with general anesthesia (GA), suitable patients receive either a local numbing injection at the surgical site or spinal anesthesia — a technique that numbs the body from the chest down while the patient stays conscious but comfortably sedated. This means no breathing tube down the throat, no machine pushing air into the lungs, and a recovery that starts much sooner.
The hospital's orthopedic and anesthesiology teams recently studied this approach by comparing 44 patients who had endoscopic lumbar spine surgery between 2023 and 2024 — a procedure to widen narrowed passages in the lower back. Half received general anesthesia. The other half stayed awake under spinal anesthesia. The surgeries typically lasted between 60 and 120 minutes. The results were striking: patients under general anesthesia were more likely to experience dangerous drops in blood pressure and abnormally slow heart rates during surgery. Those who stayed awake avoided these complications altogether.
Dr. He Yingke, a consultant in the hospital's Department of Anaesthesiology, said patients are often nervous when they learn they will not be fully asleep. "They are, in reality, comfortably sedated throughout the procedure," she explained. "Without general anesthesia, they generally experience less postoperative nausea and vomiting and an earlier return to mobility, which aids the recovery process."
The study also found that awake patients needed significantly less opioid medication — strong painkillers that carry risks like breathing problems and, in some cases, dependency. Dr. Jiang Lei, a consultant in the Department of Orthopaedic Surgery, said this matters especially as Singapore's population ages. "Many elderly patients have multiple health conditions that make surgery under general anesthesia riskier," he said. "Awake spine surgery offers an opportunity to expand access to surgical treatment for this group of patients."
Beyond narrower safety risks, the practical benefits are tangible. Associate Professor Reuben Soh, who directs spine surgery at the hospital, said patients are often walking within hours and many go home the same day. The technique has already expanded to include both micro-incision decompression surgeries and minimally invasive fusion procedures, which can treat slipped disks and worn-out spinal cushions.
With 200 procedures completed and zero conversions to general anesthesia — meaning no patient had to be urgently put to sleep mid-surgery — the team sees this as more than a one-off experiment. It is becoming a new standard.