Spinal Anesthesia in Patients with Scoliosis?

Many elderly patients presenting for total knee or total hip replacement under spinal anesthesia have scoliosis. Scoliosis can make spinal anesthesia difficult because the estimation of the midline and interspaces can be difficult. While ultrasound can be used to determine the midline, and the best insertion site for the spinal needle during spinal anesthesia, ultrasound-assisted spinal anesthesia requires a substantial degree of skill.

In a recent poll on NYSORA’s YouTube community, we asked our community members to select the paramedial technique of choice in patients with scoliosis.

In this poll, 4 options were presented, 2 options were above and below the L4-L5 level approaching the spinal anesthesia needle insertion from the concave side of scoliosis, and two options were above or below L4-L5 with insertion of the spinal needle in a paramedial technique from the convex side of scoliosis.?

What do you think is the best answer? To find out and join the discussion,?visit NYSORA’s community on YouTube?and pitch in your own opinion.