Successful neuraxial blockade under lumbar X-ray guidance in patients with ankylosing spondylitis: A series of 3 cases

Abstract

Ankylosing spondylitis poses several anesthetic challenges ranging from difficult airway to difficult neuraxial blockade. Limited cervical spine mobility, restricted opening of the temporomandibular joint, and cardiorespiratory compromise makes neuraxial anesthesia the preferred technique in these patients. However due to the ossification of the interspinous ligament and ligamentum flavum, and also syndesmophytes between adjacent vertebrae, neuraxial anesthesia poses its own set of challenges. We present a series of 3 cases in which a preoperative lumbosacral X-ray spine and fluoroscopic guidance in the operation theater allowed for an easy and more effective technique for neuraxial anesthesia in ankylosing spondylitis patients posted for transurethral resection of prostate.