Background: Posterior spinal instrumentation and fusion has traditionally been performed under general anesthesia through wide open exposures. Recent trends in orthopedics and spine surgery are shifting toward minimally invasive techniques utilizing local or regional anesthesia. These techniques have been shown to reduce perioperative morbidity and resulted in faster postoperative recovery particularly in patients with significant anesthetic risk. However, most of the reported protocols are limited to one- or two- segment spine surgeries.

Case Presentation: We report a case of a 74-year-old female who is managed as a case of spinal cord injury secondary to traumatic burst fracture of T8 and L1 untreated osteoporotic vertebral compression fracture with incomplete neurologic deficit who also presented with pleural effusion The patient underwent awake minimally invasive posterior spinal instrumentation and fusion T6-T10 with vertebroplasty of L1. Analgesia was achieved using bilateral paravertebral block on T5, T7, T9, and T11 with 0.375% ropivacaine with conscious sedation.

Results: The procedure allowed continuous neurologic monitoring intraoperatively. Postoperatively, satisfactory pain control, improvement of neurologic status and early mobilization was achieved. Post operative radiographs showed acceptable spine alignment and appropriate implant positioning.

Conclusion: Awake minimally invasive posterior spinal instrumentation is a feasible surgical option especially in patients with significant anesthetic risk. This case demonstrates that the technique can be successfully applied even in multilevel spinal procedures involving up to eight segments.