Utility of real-time ultrasound-guided spinal anesthesia in severe ankylosing spondylitis - A case report -

Background: Ankylosing spondylitis (AS) distorts the neuraxial anatomy and can complicate airway management. However, patients with severe AS are often considered unsuitable for spinal anesthesia, and attempts are typically avoided. We report a case of successful real-time ultrasound-guided spinal anesthesia in a patient with severe AS. Case: A 73-year-old man with severe AS and restrictive lung impairment presented with a femoral neck fracture and was scheduled for bipolar hemiarthroplasty. Cervical flexion deformity and whole spine ankylosis predicted difficult airway and hindered spinal anesthesia. Preprocedural ultrasound in the paramedian sagittal oblique view identified a single, small L3-4 interlaminar space. Real-time ultrasound guidance enabled intrathecal needle advancement and successful spinal anesthesia with uneventful intraoperative and immediate postoperative courses. Conclusions: Real-time ultrasound-guided spinal anesthesia can overcome severe anatomical distortion in patients with AS.