Case report of difficult intubation in a patient with ankylosing spondylitis with review of literature

Ankylosing Spondylitis is a chronic, progressive inflammatory disease of the axial skeleton and surrounding tissue causing widespread fibrous ossification of intervertebral joints and spaces leading to ankylosis. Extra articular involvement is common with severe AS manifesting as aortic insufficiency, conduction defects, restrictive lung disease and lung fibrosis. Anaesthetic challenges are plenty and compounded by the involvement of cervical vertebrae which make it arduous to manage with difficult airway and intubation protocol. After evaluating the predictors for difficult airway, the diverse modalities at disposal warrant meticulous preoperative examination and planning. Avoiding pitfalls while positioning and extubation, and managing unforeseen complications aggrandized by the pulmonary and cardiovascular involvement, make for a very intriguing study. We report a case of 50 year old male suffering from severe AS scheduled for corrective osteotomy in thoracolumbar area for correction of forward visual gaze.