Clinical Orthopaedics and Related Research®
Volume 468, Number 12, 3415-3418, DOI: 10.1007/s11999-010-1317-5Open Access

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The Association of Bone and Joint Surgeons®

Case Report

Case Report: Spinal Anesthesia by Mini-laminotomy for a Patient with Ankylosing Spondylitis who was Difficult to Anesthetize

K. H. Leung, K. Y. Chiu, Y. W. Wong and J. C. Lawmin

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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.
Each author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his institution approved the reporting of this case and that all investigations were conducted in conformity with ethical principles of research.

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