Cesarean section under spinal anesthesia in a patient with ankylosing spondylitis--a case report

It is generally accepted that neuraxial anesthesia is difficult to establish in patients with ankylosing spondylitis. General anesthesia also has some disadvantages, especially with respect to airway control in patients with ankylosing spondylitis. We present herein a gravida with ankylosing spondylitis who had a cesarean delivery performed under spinal anesthesia.

A 30-yr-old gravida at 38 weeks gestation with a 9 yr history of ankylosing spondylitis was admitted to our hospital in labor. She was scheduled for an elective repeat cesarean delivery. Spinal anesthesia was induced using a 22-gauge Quincke spinal needle with 1.8 mL of 0.5% heavy bupivacaine + 0.2 mL (10 microg) of fentanyl at the L3-4 interspace in the left lateral position by the median approach. Adequate sensory and motor blockade were achieved. The postoperative period was uneventful and she was discharged home on postoperative day 3.

We suggest that spinal anesthesia can be safely and effectively used as an alternative to general anesthesia in patients with ankylosing spondylitis. Neuraxial techniques should not be regarded as unachievable in such patients; however, all necessary precautions should be taken to avoid complications of spinal anesthesia, and facilities to secure the airway should be available.