Successful Spinal Anaesthesia in Severe Kyphoscoliosis Patient for Knee Surgery: A Case Report

Kyphoscoliosis, a complex spinal deformity, presents unique challenges in the perioperative management of patients requiring general anaesthesia as well as neuraxial anaesthesia. General anaesthesia in patients with kyphoscoliosis is challenging due to difficult airway management, reduced lung capacity, and altered pulmonary and cardiovascular mechanics, all of which increase the risk of respiratory and haemodynamic complications. Moreover, the spinal deformity complicates positioning and affects the administration of neuraxial anaesthesia, requiring careful preoperative planning and close intraoperative monitoring. We discuss a case involving a 32-year-old male with a history of childhood kyphoscoliosis, diagnosed with a left Anterior Cruciate Ligament (ACL) tear. He had no neurological abnormalities and no other complaints apart from localised pruritus in the lower abdomen. Upon evaluation, the Cobb angle measured 80º on the X-ray of the spine, and he had moderate pulmonary hypertension observed in a Two-Dimensional (2D) echocardiogram, along with restrictive lung disease without obstruction noted on spirometry. After this assessment, ACL repair under spinal anaesthesia was planned. The common problems faced during the procedure included the identification of intervertebral spaces and unpredictable spread of the spinal anaesthetic. We report the successful anaesthetic management of an adult male with severe kyphoscoliosis scheduled for left arthroscopic knee surgery under spinal anaesthesia.