Novel Use of Combined Spinal and Erector Spinae Plane Block for Long Segment Thoracolumbar Fusion: A First in Malaysia

Since its introduction in 2016, the Erector Spinae Plane Block (ESPB) has gained recognition as a promising regional anesthesia technique. However, its efficacy and safety in lumbar spine surgery remain debated due to limited clinical evidence. Conversely, Spinal Anesthesia (SA) has been increasingly acknowledged as a safe and effective alternative to General Anesthesia (GA) for elective lumbar procedures. Despite its advantages, the unfamiliarity with SA management has limited its widespread adoption in awake spine surgery. We report the first documented case in Malaysia of successful long-segment spinal fusion and decompression under combined SA and ESPB anesthesia in a 24-year-old male with L1-L2 vertebral metastases secondary to testicular cancer. The patient presented with mechanical instability, severe spinal canal stenosis and conus medullaris compression, alongside significant tracheal deviation from carinal tumor involvement, rendering GA contraindicated. Following detailed preoperative counseling, the procedure posterior instrumentation from T10 to L5 with L1-L2 laminectomy was performed uneventfully under combined SA and ESPB with sedation, utilizing a dual-surgeon approach. This case highlights the viability of combined SA and ESPB as an alternative anesthetic strategy for urgent lumbar spine surgery when GA is not feasible, demonstrating favorable perioperative outcomes.