Anesthetic Challenges in a Patient with Severe Thoracolumbar Kyphoscoliosis

Patients with thoracolumbar kyphoscoliosis present unique challenges to anesthesia. We report an interesting and challenging case of kyphoscoliosis presenting with a displaced right intertrochanteric femur fracture who was planned for spinal anesthesia. However, spinal anesthesia was not successful even with the use of intraoperative fluoroscopy. The patient was again planned for spinal anesthesia the next day after reviewing his preoperative lumbar X-rays, which were suggestive of severe canal stenosis and sclerosis of the spine at L₄-L₅ and L₅-S₁ level thus causing the failure of contrast to spread up. Using appropriate space (L₃-L₄) after viewing X-ray, successful spinal anesthesia could be given. This report underscores the importance of reviewing the preoperative radiology of the diseased spine by the anesthesiologist to administer an effective and safe spinal anesthesia in such patients.