A patient with a congenital malformation of the spine needs to be carefully evaluated prior to attempting neuraxial anesthesia. These patients may have findings that can make this form of anesthesia difficult or impossible.


Preoperative evaluation:

(1) MRI scan of the spine

(2) MRI scan of the brain

(3) evaluation of intracranial pressure

(4) neurologic exam, especially for lumbosacral nerves


Clinical findings that may impact anesthesia:

(1) lower extension of the spinal cord

(2) tethered cord or other abnormalities of the distal cord

(3) increased intracranial pressure

(4) a tumor in the filum terminale or leptomeninges

(5) bony abnormalities of the vertebral column


The presence of significant abnormalities may mean that neuraxial anesthesia is impossible to perform safely and an alternative strategy will be required.


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