# Management of a Patient With Ankylosing Spondylitis and Multiple Comorbidities Who Underwent a Percutaneous Nephrolithotomy Using an Innovative Positioning Strategy **Authors:** Ranjay Mahaseth, Mridul Dhar, Revanth B Challa, Vikas K Panwar, Ravi Chaudhary PMC · DOI: 10.7759/cureus.51455 · Cureus · 2024-01-01 ## TL;DR This paper describes a case where a patient with ankylosing spondylitis and multiple health issues safely underwent a kidney stone surgery using a special positioning method. ## Contribution The paper introduces an innovative positioning strategy for percutaneous nephrolithotomy in patients with ankylosing spondylitis. ## Key findings - Ankylosing spondylitis poses challenges for airway and surgical positioning. - A customized anaesthetic and surgical approach enabled safe procedure completion. - The innovative positioning strategy proved effective for this complex case. ## Abstract Ankylosing spondylitis (AS) is a chronic inflammatory disorder leading to bony ankylosis, ossification, and fibrosis of the spine. Airway management is difficult in these patients due to restricted head and neck movement as well as a stiff body posture. This also poses challenges in lying down supine as well as surgical positioning. We report a case of a patient with AS and multiple co-morbidities who underwent a percutaneous nephrolithotomy for renal calculi, and the customisations made in anaesthetic and surgical techniques to safely perform the procedure. ## Linked entities - **Diseases:** Ankylosing spondylitis (MONDO:0005306) ## Full-text entities - **Diseases:** fracture (MESH:D050723), AS (MESH:D013167), renal calculi (MESH:D007669), hyperextension (MESH:C563315), flexion deformity of the neck and spine (MESH:D006258), bony deformities (MESH:D018213), pneumothorax (MESH:D011030), spine (MESH:D016135), inflammatory disorder (MESH:D007249), fusion (MESH:D000069337), CKD (MESH:D051436), ossification (MESH:C562735), shortness of breath (MESH:D004417), respiratory complications (MESH:D012140), hip injury (MESH:D025981), hypercapnia (MESH:D006935), cervical injury (MESH:D002575), hypertension (MESH:D006973), flexion deformity (MESH:D009140), emphysematous (MESH:D041882), bony ankylosis (MESH:D000844), COPD (MESH:D029424), bullae rupture (MESH:D001768), thoracic kyphosis (MESH:D007738), fibrosis (MESH:D005355), neuraxial block (MESH:D006327) - **Chemicals:** propofol (MESH:D015742), levosalbutamol (MESH:D064412), carbon dioxide (MESH:D002245), atracurium (MESH:D001279), lignocaine (MESH:D008012), oxygen (MESH:D010100), fentanyl (MESH:D005283), ipratropium (MESH:D009241), H2O (MESH:D014867) - **Species:** Homo sapiens (human, species) [taxon 9606] ## Full text _Full body text omitted from this summary view._ Fetch the complete paper as Markdown: https://tomesphere.com/paper/PMC10829528/full.md ## Figures 2 figures with captions in the complete paper: https://tomesphere.com/paper/PMC10829528/full.md ## References 5 references — full list in the complete paper: https://tomesphere.com/paper/PMC10829528/full.md --- Source: https://tomesphere.com/paper/PMC10829528