engleski

Subspinous midline approach for SA in adult thoracolumbal scoliosis and/or kyphosis

Adult scoliosis is spinal deformity in a skeletally mature patient with a Cobb angle of more than 10 degrees in the coronal plain followed by deformity of the rib cage1 2. Spinal anaesthesia (SA) could be allowed in patients with scoliosis and lower extremity trauma if sufficient respiratory and cardiac functions are present. Increased deformity progression in the adult spine characterized by associated multiple asymmetric degenerative changes (spinal stenosis, spondylolisthesis, rotational subluxation, lumbar hypolordosis, rigidity) resault in high unsuccesful midline and paramedial approuch in SA, We would like to present an modification in medline technique approch for SA in scoliosis patients in high ages with nonoperative care. 60 patients (age 74+/-7, F/M ratio1.5, BMI 23+/-5, ASA II/III status) with adult thoracolumbal scoliosis/kyphosis and trauma hip fracture were included in the study during three years period. The SRS classificaion for adult spinal deformity was chosen to determine spine curve types and its modifiers (lordosis, subluxation, sagital balance). The inclusion criteria were Type II location of deformity (upper thoracic major, apex Th4-8 with thoracolumbar or lumbar curve) and the maximal coronal Cobb angle of 20o Patients were randomized in three equal groups where midline (Group M), paramedial (Group PM) and "subspinous midline" approach (Group SM) were used. All patient were punctured by Sprotte needle (26G) with introducer. Levibupivacain 0.5% (12.5 mg) was given immediately after CSF detection. The successful of the SA block and technical characteristics of each approach were noted. Data were analyzed by ANOVA and Chi-Square test. Study groups were comparable in demographic data. "Subspinous midline" (18 ; 85%) and paramedial approach (14 ; 70%) for SA in Typ II scoliosis with toracolumbal deformity were significantly more successful techniques to compare midline approach (4 ; 20%)(Chi-Squere=95.315, p=0.0000). One single punction’s attempt without complications was found in the most patients of Group SM (15 ; 75%, Group PM 6 ; 30%, Group M 1 ; 5%). One single puncture with need for needle reinsertion was more often in Group PM (7 ; 35%, Group M=0, Group SM 5 ; 25%). In Group PM also increase the incidences of 2-3 punctures on the same level (7 ; 35%) as the accidental venepuntion (6 ; 30%)(Chi-Squere=204.000, p=0.0000). "Subspinous midline" approach of SA is good and successful new alternative to paramedial approach in patients with Typ II thoracolumbal scoliosis.

adult spinal deformity; spinal anesthesia; trauma hip fracture

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