A Systematic Review Of Neuraxial Anesthesia In Patients With Ankylosing Spondylitis

Abstract

Objectives: Ankylosing spondylitis is a rare disease that presents difficulties for general and regional anesthesia techniques in patients undergoing surgery. Thoracic kyphosis, flattening of the lumbar spine, and in patients with advanced stage AS, formation of syndesmophytes can complicate neuraxial anesthesia. This review examines spinal, epidural, and caudal anesthesia practices for patients with ankylosing spondylitis. Methods: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, an electronic literature search was performed by three authors on 01.01.2017 without history limitation. English articles that reviewed neuraxial anesthesia applications for cases with ankylosing spondylitis were included. Results: In total, 17 articles with 20 patients were included. Most cases were males (16; 80%). Spinal anesthesia was performed for 40% of patients (thoracic epirak anesthesia, 25%; lumbar epidural anesthesia, 15%; caudal anesthesia, 10%; combined spinal-epidural anesthesia, 10%). A median approach was selected for eight patients (40%), whereas a paramedian approach was selected for seven patients (35%). Of the 20 approaches, three failed (15%). While the most application region was the thoracic region (45%; nine cases), generally (90%) no imaging technique was used. Conclusion: We believe that in patients with syndesmophyte formation in the thoracic or lumbar regions, the paramedian approach should be considered as a useful alternative to the median approach, or an imaging technique may also be used.