Anesthesia and Ankylosing Spondylitis

Mark Wagner CRNA, M.S.

Ankylosing Spondylitis

Ankylosis - Stiffening or fixation of a joint as a result of a disease process, with fibrous or bony union across the joint; fusion.

Spondylitis - Inflammation of one or more of the vertebrae.

Spondylosis - Ankylosis of the vertebrae.

Overview: Rheumatic, autoimmune

Inflammation of spine/Sacroiliac joints/Pelvis

Strong genetic predisposition

- Autosomal dominant; HLA B27 genotype.

Males > Females (3:1)

Diagnosis of AS

Schober test

Gaenslen test

Neuro evaluation

Radiographic evidence

AS Pathophysiology

“Bamboo Spine”

Ankylosing Spondylitis

Sacroiliac Involvement

Iritis or Anterior Uveitis

Inflammation of the eye

Signs and symtoms:

-Redness, pain, sensitivity to light and skewed vision.

Treatment:- Cortcosteroid eyedrops

AS Treatment

NSAIDS (Indomethacin)

Sulphasalazine

Exercise/Physical therapy

Surgery

- Hip/shoulder arthroplasty, osteotomy, decompression and fusion.

Spondylolysis

Term used to describe

the presence of a “defect”

or stress fracture in the

posterior arch of the

vertebrae.  It occurs at the

lumbo-sacral junction

(L5/S1) in about 85% of

cases. 

Respiratory Abnormalities

Restrictive disease

compliance

vital capacity

Upper lobe fibrosis

Cricoarytenoid Arthritis

Cricoarytenoid joints

Abduct and adduct

vocal cords

Hoarseness

RD and stridor

TMJ Ankylosis

Limited movement in 10% of pts.

In advanced disease, 30-40% affected

May progress to complete ankylosis and inability to open mouth

Awake fiber-optic nasal intubation should be considered

Cardiovascular Abnormalities

Aortic insufficiency/Aortitis

Cardiomyopathy

Angina

Conduction abnormalities

Neurological Abnormalities

Spinal stenosis

Radicular pain/Paresthesias

Cauda equina syndrome

Vertebral fractures

Pre-Operative Evaluation

H+P

- Activity tolerance

AIRWAY!- Cervical ROM, MO

ability to lie flat

Chest/spine films

- Severity/location

Pre-Operative Evaluation

Pulmonary function- PFT’s, ABG, breath sounds

Cardiovascular- Cardiac anomalies, 2-D ECHO,

stress test, cath results

Labs- CBC, Chem 7, Coags, T+C

AS and Anesthesia

Awake fiber-optic intubation

Trach under L.A.

Regional anesthesia-Spinal, Epidural, Caudal

Positioning

Questions?