Download

Download Full Text (219 KB)

Description

Ankylosing spondylitis (AS) is a chronic, inflammatory autoimmune disease that involves structural spinal changes, which can pose increased risks for airway failure or spinal cord injury during intubation and airway management. AS may cause spinal ligaments to ossificate and the annulus fibrosis of the intervertebral disc(s) to calcify, resulting in a "bamboo spine" appearance on radiographic imaging. Physiological changes include a limited atlanto-occipital extension, restricted oral aperture, and positional intolerance while supine due to fixed cervical flexion from spinal fusion. As such, airway management and positioning for patients with AS requires a careful, individualized approach.

A 75 year old male with AS, essential HTN, and GERD presented to the ED after a fall carrying his groceries. On exam, he showed decreased BLE sensation, 0/5 strength in his lower extremities, and exaggerated cervical kyphosis. CT of his cervical spine demonstrated a nondisplaced transverse fracture through the mid body of T1, a nondisplaced fracture of the posterior lamina of C7 bilaterally, and an epidural hematoma at C6-T2. MRI was considered but due to significant kyphosis, there was a concern that he could not fit in the machine. Due to his progressing complete paraplegia, it was decided that an emergent laminectomy and evacuation of the spinal hematoma needed to be done.

Careful preoperative planning and communication between healthcare teams is essential for safe positioning and intubation for AS patients with severe kyphosis. Videolaryngoscopy must be avoided due to the risk of a hyperextension injury to the neck. Awake nasal fiberoptic intubation with topical anesthesia is the gold standard for AS patients with severe cervical kyphosis. When placing such patients in the prone position rigid head stabilization and proper padding are needed to maintain spinal curvature and prevent iatrogenic injury.

Publication Date

5-8-2026

Disciplines

Anesthesiology

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2105

Navigating a Difficult Airway and Positioning Challenges in a Patient with Severe Ankylosing Spondylitis

Share

COinS