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Abstract
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Background and Aims Ankylosing spondylitis (AS) is a chronic, progressive inflammatory disease that affects the spine and sacroiliac joints. Disease spectrum may range from mild rigidity to bone fusion of the spine. Inevitably, neuraxial blockade may be technically difficult or impossible to achieve due to closed interspinous spaces and loss of flexibility. Tracheal intubation may also be difficult because of the involvement of cervical spine and temporomandibular joint. Cardiopulmonary complications are frequently present, demanding a careful pre-operative evaluation.
Methods A 69-year-old woman with a long history of AS presented for hip replacement surgery. The patient had a bamboo spine with accentuated thoracolumbar kyphosis and no mobility of cervical spine, which was fixed in a flexed posture. After positioning in right lateral decubitus, spinal anesthesia was achieved after 3 attempts, at L3-L4 interspace, paramedian approach, with a 25G Quincke needle. 9 mg of isobaric bupivacaine 0,5% and 2 mcg of sufentanyl were administered. Ultrasound guided femoral nerve block and lateral femoral cutaneous nerve block were previously successfully performed.
Results The sensory and motor blocks were adequate, and the patient remained hemodynamically stable thorough surgery.
Positioning
Cervical spine fixed
Conclusions AS presents significant challenges to the anesthesiologist, thus requiring a careful anesthetic planning. Regarding regional anesthesia, the major concerns are the difficulty of the technique, increased risk of complications and the unpredictable sensory and motor spread of the neural blockade. If general anesthesia is necessary, awake fiber optic intubation should be considered, and cardiopulmonary pathology held in consideration.