Case report: Spinal anesthesia by mini-laminotomy for a patient with ankylosing spondylitis who was difficult to anesthetize

Clin Orthop Relat Res. 2010 Dec;468(12):3415-8. doi: 10.1007/s11999-010-1317-5. Epub 2010 Mar 19.

Abstract

Background: Orthopaedic surgeons frequently encounter patients with ankylosing spondylitis who would benefit from various types of lower limb operations; however, some of these patients present challenges for anesthesiologists.

Case description: We report the case of a 65-year-old patient with a fractured femoral component 30 years after a cemented THA. The patient had severe tracheal stenosis and ankylosing spondylitis making general endotracheal and conventional neuraxial anesthesia nearly impossible.

Literature review: Possible alternative anesthetic approaches described in the literature include awake fiberoptic bronchoscopic guided intubation, laryngeal mask airway, and caudal anesthesia.

Purposes and clinical relevance: We achieved successful anesthesia using spinal laminotomy with the patient under local anesthesia followed by insertion of a spinal catheter and injection of an anesthetic agent. The loosened component was revised to a cementless THA.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Anesthesia, Spinal / methods*
  • Arthroplasty, Replacement, Hip*
  • Hip Joint / diagnostic imaging
  • Hip Joint / surgery*
  • Humans
  • Laminectomy*
  • Male
  • Reoperation
  • Spondylitis, Ankylosing / complications
  • Spondylitis, Ankylosing / diagnostic imaging
  • Spondylitis, Ankylosing / surgery*
  • Tomography, X-Ray Computed
  • Treatment Outcome