Ultrasound-assisted neuraxial anaesthesia in an adult patient with repaired spina bifida, scoliosis and difficult airway.

Patients with spina bifida (SB) undergoing neuraxial anaesthesia have increased risk of further neurologic injury due to altered spinal anatomy. Meanwhile, scoliosis is associated with concomitant restrictive lung diseases. While research has been focused on managing secondary comorbidities related to SB, limited attention has been given to perioperative anaesthetic care of its increasing adult population. This case presents a woman in her 30s with repaired SB, scoliosis and predicted difficult airway. She was diagnosed with oxygen-requiring pneumonia and bilateral popliteal ulcers for elective debridement. Ultrasound-assisted neuraxial technique was performed to administer isobaric bupivacaine into the L4-L5 intrathecal space. This report highlights the efficient use of ultrasound as an alternative to traditional landmark-based technique in cases of severe scoliosis and SB. A patient-centred anaesthetic plan-emphasising preoperative optimisation, haemodynamic and respiratory stability, immobility and postoperative pain control-is critical for optimal perioperative outcomes in this complex population.