Fibrodysplasia ossificans progressiva: anesthetic management in complex orthopedic spine procedures

Fibrodysplasia ossificans progressiva (FOP) is a rare disorder of the connective tissue leading to progressive tissue ossification and immobilization. Soft-tissue trauma may exacerbate this condition, causing further ossification. Multisystem involvement includes restrictive lung disease, cervical ankylosis with limited mouth opening, and cardiac dysfunction. A 39-year-old woman with FOP presented with multiple orthopedic spine and femur fractures sustained from a fall. Anesthetic management was complicated by airway, pulmonary, and positioning challenges. Neuromonitoring allowed identification of spinal cord ischemia while avoiding a wake-up test.