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Spinal Anesthesia Application in a Patient with Ankylosing Spondylitis By Paramedian Approach

Year 2014, Volume: 15 Issue: 2, 82 - 84, 01.08.2014

Abstract

Ankylosing spondylitis is a chronic, progressive seronegative spondyloarthropathy that is rare among surgical patients and in which application of both general and regional anesthesia is difficult. A 38 years-old, and 170 cm height, 82 kg weight, ASA class II male patient assigned for an elective left spermatocell surgery, has been followed for Ankylosing Spondylitis since 14 years. Spinal anesthesia was planned beacuse of serious limitation of extension at cervical joints. However, spinal anesthesia was applied to patient, in whom insertion of needle was impossible because of lumbar flattening and formation of syndesmophytes, by paramedain approach at L4-5 spinal space. In conclusion we think that success rate may increase by paramedian approach in patients with advanced stage Ankylosing Spondylitis.

References

  • 1. Van der Horst-Bruinsma IE, Lems WF, Dijkmans BA. A systematic comparison of rheumatoid arthritris and ankylosing spondylitis. Clin Exp Rheumatol 2009;27:43-9.
  • 2. Inman RD. The Spondyloarthropathies. In: Goldman L, Schafer AI editors, Goldman’s Cecil Medicine. 24th edition, Elsevier Saunders, Philadelphia, 2012, 1690-96. [CrossRef]
  • 3. Mielants H, Van den Bosch F. Extra-articular manifestations. Clin Exp Rheumatol 2009;27:56-61.
  • 4. Khan MA. Ankylosing spondylitis: the clinical aspects. In: Calin A, Taurog J. editors, The spondylarthritides. Oxford Universiy Press Oxford 1998;27-40.
  • 5. Sivrikaya GU, Hanci A, Dobrucali H, Yalcinkaya A. Cesarean section under spinal anesthesia in a patient with ankylosing spondylitis--a case report. Middle East J Anesthesiol 2010;20:865-8.
  • 6. Jindal P, Chopra G, Chaudhary A, Rizvi AA, Sharma JP. Taylor’s approach in an ankylosing spondylitis patient posted for percutaneous nephrolithotomy: A challenge for anesthesiologists. Saudi J Anaesth. 2009;3:87-90. [CrossRef] ADU Tip Fak Derg 2014; 15(2): 82-4 Öztürk ve ark. Ankilozan Spondilit ve Spinal Anestezi
  • 7. Hyderally HA. Epidural hematoma unrelated to combined spinal-epidural anesthesia in a patient with ankylosing spondylitisreceiving aspirin after total hip replacement. Anesth Analg 2005;100:882-3. [CrossRef]
  • 8. Sng BL, Shah MK. Regional anaesthesia for Caesarean section in an ankylosing spondylitic patient with twin pregnancy. Eur J Anaesthesiol 2008;25:767-9. [CrossRef]
  • 9. Leung KH, Chiu KY, Wong YW, Lawmin JC. Case report: Spinal anesthesia by mini-laminotomy for a patient with ankylosing spondylitis who was difficult to anesthetize. Clin Orthop Relat Res 2010;468:3415-8. [CrossRef]
  • 10. Chin KJ, Chan V. Ultrasonography as a preoperative assessment tool: predicting the feasibility of central neuraxial blockade. Anesth Analg 2010;110:252-3. [CrossRef]
  • 11. Canakcı N, Unsal M, Aydemir A, Ates Y. Successful Spinal Anesthesia in a Case of Ankylosing Spondylitis. T Klin J Med Sci 2001;21:307-10.
  • 12. Kumar CM, Mehta M. Ankylosing spondylitis: lateral approach to spinal anaesthesia for lower limb surgery. Can J Anaesth 1995;42:73-6. [CrossRef]
  • 13. Schelew BL, Vaghadia H. Ankylosing spondylitis and neuraxial anaesthesia - a 10 year review. Can J Anaesth 1996;43:65-8. [CrossRef]
  • 14. Batra YK, Sharma A, Rajeev S. Total spinal anaesthesia following epidural test dose in an ankylosing spondylitic patient with anticipated difficult airway undergoing total hip replacement. Eur J Anaesthesiol 2006;23:897-8. [CrossRef]
  • 15. Allen D, Dahlgren N, Nellgård B. Risks and recommendations in Bechterew disease. Paraparesis after epidural anesthesia. Lakartidningen 1997;94:4771-4.
  • 16. Wulf H. Epidural anaesthesia and spinal hematoma. Can J Anaesth 1996;43:1260-71. [CrossRef]

Ankilozan Spondilitli Hastada Paramedian Yaklaşımla Spinal Anestezi Uygulaması

Year 2014, Volume: 15 Issue: 2, 82 - 84, 01.08.2014

Abstract

Ankilozan Spondilit, cerrahi hastalarda nadir görülen ve hem genel hem de rejyonal anestezi uygulamasının zor olduğu bir kronik, ilerleyici seronegatif spondiloartropatidir. Sol spermatosel nedeni ile elektif cerrahi planlanan, 38 yaşında ve 170 cm boyunda, 82 kg ağırlığında, Amerikan Anestezistler Derneği fiziksel sınıflaması (ASA) II olan erkek hastada yaklaşık 14 yıldan beri Ankilozan spondilit bulunmaktaydı. Servikal eklemlerinde ciddi düzeyde ekstansiyon kısıtlaması olduğundan spinal anestezi planlandı. Ancak lomber düzleşme ve sindezmofit oluşumu nedeni ile median yaklaşımla iğne girişi mümkün olmayan hastaya L4-5 aralığından paramedian yaklaşımla spinal anestezi uygulandı. Sonuç olarak ileri safhadaki Ankilozan Spondilitli hastalarda paramedian yaklaşımla spinal anestezi başarı oranının artabileceği kanısındayız

References

  • 1. Van der Horst-Bruinsma IE, Lems WF, Dijkmans BA. A systematic comparison of rheumatoid arthritris and ankylosing spondylitis. Clin Exp Rheumatol 2009;27:43-9.
  • 2. Inman RD. The Spondyloarthropathies. In: Goldman L, Schafer AI editors, Goldman’s Cecil Medicine. 24th edition, Elsevier Saunders, Philadelphia, 2012, 1690-96. [CrossRef]
  • 3. Mielants H, Van den Bosch F. Extra-articular manifestations. Clin Exp Rheumatol 2009;27:56-61.
  • 4. Khan MA. Ankylosing spondylitis: the clinical aspects. In: Calin A, Taurog J. editors, The spondylarthritides. Oxford Universiy Press Oxford 1998;27-40.
  • 5. Sivrikaya GU, Hanci A, Dobrucali H, Yalcinkaya A. Cesarean section under spinal anesthesia in a patient with ankylosing spondylitis--a case report. Middle East J Anesthesiol 2010;20:865-8.
  • 6. Jindal P, Chopra G, Chaudhary A, Rizvi AA, Sharma JP. Taylor’s approach in an ankylosing spondylitis patient posted for percutaneous nephrolithotomy: A challenge for anesthesiologists. Saudi J Anaesth. 2009;3:87-90. [CrossRef] ADU Tip Fak Derg 2014; 15(2): 82-4 Öztürk ve ark. Ankilozan Spondilit ve Spinal Anestezi
  • 7. Hyderally HA. Epidural hematoma unrelated to combined spinal-epidural anesthesia in a patient with ankylosing spondylitisreceiving aspirin after total hip replacement. Anesth Analg 2005;100:882-3. [CrossRef]
  • 8. Sng BL, Shah MK. Regional anaesthesia for Caesarean section in an ankylosing spondylitic patient with twin pregnancy. Eur J Anaesthesiol 2008;25:767-9. [CrossRef]
  • 9. Leung KH, Chiu KY, Wong YW, Lawmin JC. Case report: Spinal anesthesia by mini-laminotomy for a patient with ankylosing spondylitis who was difficult to anesthetize. Clin Orthop Relat Res 2010;468:3415-8. [CrossRef]
  • 10. Chin KJ, Chan V. Ultrasonography as a preoperative assessment tool: predicting the feasibility of central neuraxial blockade. Anesth Analg 2010;110:252-3. [CrossRef]
  • 11. Canakcı N, Unsal M, Aydemir A, Ates Y. Successful Spinal Anesthesia in a Case of Ankylosing Spondylitis. T Klin J Med Sci 2001;21:307-10.
  • 12. Kumar CM, Mehta M. Ankylosing spondylitis: lateral approach to spinal anaesthesia for lower limb surgery. Can J Anaesth 1995;42:73-6. [CrossRef]
  • 13. Schelew BL, Vaghadia H. Ankylosing spondylitis and neuraxial anaesthesia - a 10 year review. Can J Anaesth 1996;43:65-8. [CrossRef]
  • 14. Batra YK, Sharma A, Rajeev S. Total spinal anaesthesia following epidural test dose in an ankylosing spondylitic patient with anticipated difficult airway undergoing total hip replacement. Eur J Anaesthesiol 2006;23:897-8. [CrossRef]
  • 15. Allen D, Dahlgren N, Nellgård B. Risks and recommendations in Bechterew disease. Paraparesis after epidural anesthesia. Lakartidningen 1997;94:4771-4.
  • 16. Wulf H. Epidural anaesthesia and spinal hematoma. Can J Anaesth 1996;43:1260-71. [CrossRef]
There are 16 citations in total.

Details

Other ID JA32KZ77GY
Journal Section Case Report
Authors

İbrahim Öztürk This is me

Jülide Ergil This is me

Derya Özkan This is me

Eylem Oğuz This is me

Mesut Bakır This is me

Publication Date August 1, 2014
Published in Issue Year 2014 Volume: 15 Issue: 2

Cite

EndNote Öztürk İ, Ergil J, Özkan D, Oğuz E, Bakır M (August 1, 2014) Spinal Anesthesia Application in a Patient with Ankylosing Spondylitis By Paramedian Approach. Meandros Medical And Dental Journal 15 2 82–84.