Background: Airway management in patients with ankylosing spondylitis (AS) poses significant anesthetic challenges, especially in advanced stages characterized by severe spinal deformities, reduced cervical mobility, and fixed flexion contractures. These anatomical limitations complicate tracheal intubation and elevate the risk of airway-related complications. Case presentation: We report a case of a 63-year-old male diagnosed with advanced-stage AS, exhibiting a 60-degree fixed thoracolumbar kyphosis and cervical spine ankylosis. The patient who had cervical rigidity with impaired extension, underwent awake nasal intubation using flexible fiberoptic bronchoscopy. The procedure was well-tolerated, and spinal tumor resection proceeded uneventfully under intraoperative neurophysiological monitoring. Conclusion: This case highlights the importance of comprehensive preoperative airway evaluation and individualized planning in patients with advanced ankylosing spondylitis. Awake fiberoptic-guided intubation can offer a safe and effective approach to securing the airway in anatomically challenging cases.
Le et al. (Tue,) studied this question.