When UNC Health patient Marlene D. learned she needed a cyst removed from her lumbar facet joint, her biggest concern wasn’t the surgery. It was the anesthesia. UNC’s Minimally Invasive Spine Surgery and Motion Preservation Program Director and Professor of Neurosurgery Cheerag Upadhyaya, MD, MBA, MSc, FAANS, FACS, listened to his patient’s needs. He consulted with UNC’s Director of Neuroanesthesia and Associate Professor of Anesthesiology Sam Blacker, MD, FASA, and on October 6th 2025, the collaborating physicians led a multi-disciplinary team that performed UNC Medical Center’s first awake spine surgery.
Marlene reflected: “I did not want to go under General Anesthesia. Dr. Upadhyaya LISTENED to my concerns about the anesthesia. I was thrilled to learn that AWAKE spine surgery was an alternative. The team prepared me well for every step and what was to occur. The entire procedure I was both awake and comfortable, and I could not have asked for a team of more caring and skilled hands. Success! Pain-free! A+.”
A highly regarded minimally invasive spine surgeon, Dr. Upadhyaya studies improved patient outcomes in part through pursuing novel approaches to his cases. He stated:
“Today we completed UNC’s first ‘awake’ spine surgery — a patient-centered milestone made possible by meticulous planning and a phenomenal multidisciplinary team across anesthesia, nursing, and neurosurgery. This achievement reflects our commitment to innovation in service of safety, comfort, and faster recovery. It’s not just a technical first, but a demonstration of how thoughtful collaboration and preparation can elevate patient care.” 
As UNC Anesthesiology’s Support Services Medical Director, Dr. Blacker oversees planning, prioritizing, and securing equipment for current and future patient care, as well as compliance with all regulations, certifications, and safety initiatives. Dr. Blacker serves on UNC Health’s Innovation team and is a influential contributor to planning complex neurosurgery procedural cases at UNCMC. To conduct this first-of-kind, minimally invasive spine surgery, Drs. Blacker and Upadhyaya planned a patient-centered case for an adult who could safely undergo removal of a spinal cyst with a regional anesthetic in place.
Dr. Blacker stated: “Awake spine surgery, conducted with a spinal anesthetic, is a safe and viable option for appropriately selected patients and procedures. We are always exploring options to better serve our patients, and the neurosurgeons were very excited to offer this modality to their patients. This successful surgery represents another way to improve outcomes and enhancing the overall patient experience that is always a team effort.
I want to especially recognize Natalie Campbell for volunteering to take on this case. Natalie performed a flawless, single attempt, spinal anesthetic and kept the patient comfortable throughout and ensured UNC’s first awake spine surgery went smoothly.”