Transforaminal sacral approach for spinal anesthesia in orthopedic surgery: A novel approach

Abstract

Regional anesthesia is preferred world-wide for its distinct advantages. The benefits of regional anesthesia in patients with comorbid conditions are well-established. The administration of regional anesthesia can sometimes pose a challenge to the anesthesiologist due to the structural abnormalities of the spine. The most common difficulty encountered for spinal anesthesia in our hospital (Nalgonda District) is skeletal fluorosis. Apart from the midline approach, paramedian, and Taylor's approaches are advocated for difficult scenarios. This article reports two orthopedic cases, conducted under a novel spinal anesthesia technique, i.e., transforaminal sacral approach under C-arm guidance with a successful outcome. The sacral foraminal subarachnoid block is a method to access the subarachnoid space through the upper posterior sacral foramina.

Chronic fluorosis: The disease and its anaesthetic implications

“…[ 11 ] “Poker back” spine (kyphosis) is a late manifestation of skeletal fluorosis wherein the entire spine becomes one continuous column of bone. [ 4 13 ] In the final stage, the patient is left crippled. [ 14 ]…”

“…Use of techniques like C-arm, ultrasonic guidance, paramedian approach and Taylor's approach can be adopted in such cases. [ 13 47 ] Successful use of transforaminal sacral approach for spinal anaesthesia has been reported for cases of chronic fluorosis. [ 13 ] Elective post-operative mechanical ventilation and Intensive Care Unit care may be needed in patients with severe reduction in pulmonary function, especially after major/prolonged surgery Care should be taken to avoid excessive neck movements during airway instrumentation/placing neck catheters/surgery.…”

“…Use of techniques like C-arm, ultrasonic guidance, paramedian approach and Taylor's approach can be adopted in such cases. [ 13 47 ] Successful use of transforaminal sacral approach for spinal anaesthesia has been reported for cases of chronic fluorosis. [ 13 ]…”