Fluoroscopy guided transforaminal epidural anesthesia in ankylosing spondylitis

Abstract

A 48-year-old male patient with a long-standing history of ankylosing spondylitis (AS) presented for ureteroscopic stone removal. On preoperative assessment, tracheal intubation was likely to be difficult due to decreased cervical spine mobility. Traditional neuraxial block was impossible due to the fusion of vertebral bodies. AS patients present the most serious array of intubation, which is secondary to decrease in cervical spine mobility and possible temporomandibular joint disease. Management of a case of AS can be very challenging when the airway and the central neuraxial blockade, both are difficult. Fluoroscopic assisted central neuraxial blockade may lead to predictable success in AS. We present a case report with severe AS where conventional techniques failed and C-arm assisted helped in successful epidural anesthesia for ureteroscopic stone removal.

Using Lumbar X-Ray to Facilitate Modified Taylor’s Approach of Spinal Anesthesia in an Elderly Patient With Scoliosis

“…In cases when visualization is not adequate with ultrasonography, fluoroscopy is sometimes used. Live fluoroscopy is even more limited than ultrasonography as it relies on the availability of equipment and trained operators [ 19 , 20 ].…”

Fluoroscopic-guided paramedian approach to subarachnoid block in patients with ankylosing spondylitis: A case series

“…[ 5 6 ] The literature evaluating the utility of image-guidance for SAB in AS is scant; limited only to individual case reports. [ 6 7 ] Fluoroscopy guided transforaminal approach has been reported to facilitate SAB in a patient with AS. [ 7 ] However, the transforaminal approach may be associated with higher incidence of encountering the exiting spinal nerve root, inducing distressing paraesthesia and nerve root injury.…”

“…[ 6 7 ] Fluoroscopy guided transforaminal approach has been reported to facilitate SAB in a patient with AS. [ 7 ] However, the transforaminal approach may be associated with higher incidence of encountering the exiting spinal nerve root, inducing distressing paraesthesia and nerve root injury. [ 8 ] The paramedian approach avoids the ossified midline ligaments [ Figure 1 ] and has a lower risk of encountering the exiting spinal nerve root.…”

Fluoroscopy Comes to the Rescue in Anaesthesia Management of a Case of Ankylosing Spondylitis

“…Fluoroscopy forms an integral part in various interventions done in orthopaedic and neurosurgeries. The use of C-Arm helps as a guide in chronic pain intervention procedures but it's use in the practice of regional anaesthesia techniques is rare though known [1]. Ankylosing spondylitis (AS) being a chronic inflammatory disease of the axial skeleton and peripheral joint [2] has always been a challenge to the anaesthesiologist for its known association with difficult airway or a seemingly impossible central neuraxial blockade.…”