Article Text
PDF
Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)
Background and Aims The prevalence of Lumbar spinal stenosis ranges from 11 to 39% (Jensen R.K, et al, 2020). A recent paper from Denmark reveals that 46% of those with Lumbar spinal stenosis underwent decompression surgery (Jensen R.K, et al, 2023). Patients presenting with a history of spine surgery is not infrequent these days.
Methods We present a 76-year-old lady posted for a Total Knee Arthroplasty who had lumbar decompression with fusion from L2 to L5. She had her hips replaced under spinal anaesthesia prior to the spine-surgery. She was keen to have this surgery under a spinal anaesthetic. Mr J A Taylor, a Urologist, first described spinal anaesthesia at L5-S1 for procedures on the prostate and bladder (Taylor, 1940). The spinal tap was performed with the patient in prone position using a paramedian approach 1 cm inferomedial to the posterior superior iliac spine. As her fusion extended from L2 to L5, we opted for a modified Taylor’s approach with the patient in sitting position.
Results A pre-procedure ultrasound scan was performed to evaluate and identify the L5 – S1 space. The ligamentum flavum-dura mater complex was identified on the right paramedian sagittal oblique view and the entry point was marked. The spinal anaesthetic was performed successfully in a single attempt.
Conclusions Challenging spinal anatomy does not mandate the use of a general anaesthetic. Previously described techniques like Taylor’s approach combined with the use of ultrasound can improve the success of neuraxial anaesthesia. This can improve patient outcome and satisfaction.
X-ray showing scoliosis with Harrington rods in-situ