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

Abstract

In geriatric patients scheduled for hip or knee surgery, neuraxial anesthesia is a safe and effective anesthesia method and may be a better option than general anesthesia. Unfortunately, establishing neuraxial anesthesia is not always easy in this group of patients. Anatomical abnormalities, such as spinal stenosis, scoliosis, and narrowed interspaces, contribute to the difficulties that anesthesiologists face while performing these procedures. The classic Taylor’s approach targets the widest interspace, L5-S1, as the needle insertion site and accordingly has an increased success rate in difficult neuraxial anesthesia. As this technique historically relies solely on palpation, it might be difficult in patients with less prominent or distorted anatomic landmarks. Ultrasonography or fluoroscopy guidance may help to better target the epidural or subarachnoid space, but both have limitations due to equipment availability or provider expertise. The modified Taylor’s approach we propose in this case report is based on preoperative lumbar x-ray interpretation when point-of-care image guidance cannot be performed. By measuring on the patient’s preoperative lumbar x-ray, we successfully performed a modified Taylor's approach of spinal anesthesia on an elderly patient with severe scoliosis. She underwent open reduction and internal fixation (ORIF) of the left femur with satisfactory pain control and no complications.

Regional anesthesia for geriatric population

“…[ 93 ] A modified technique to Taylor’s approach using pre-procedural lumbar X-ray to locate the space and insertion point in elderly patients had been described too. [ 94 ] Imaging modalities such as X-ray, fluoroscopy, and pre-procedural CT scans can be utilized; however, they have the disadvantages of not being readily available and the risk of radiation.…”