Osteopathic musculoskeletal examination and subarachnoid anesthetic administration in a patient with severe scoliosis

J Am Osteopath Assoc. 2014 Jul;114(7):582-5. doi: 10.7556/jaoa.2014.112.


Physicians primarily use palpation of anatomical landmarks to guide the placement of needles when administering neuraxial anesthetics. For patients with anatomical abnormalities such as scoliosis, it is also important for physicians to understand Fryette mechanics and spinal curvature anatomy, as well as preprocedural radiography and ultrasonography, to ensure accuracy in neuraxial anesthetic procedures. The authors report the case of a patient with severe scoliosis who required neuraxial anesthesia for total hip arthroplasty. Using palpation and imaging, his physicians were able to successfully administer a subarachnoid anesthetic injection on the first attempt. The authors discuss considerations for improving success rates of neuraxial anesthetic administration in these patients.

Publication types

  • Case Reports

MeSH terms

  • Anesthetics / administration & dosage*
  • Arthroplasty, Replacement, Hip
  • Humans
  • Injections, Spinal
  • Lumbar Vertebrae
  • Male
  • Middle Aged
  • Osteoarthritis, Hip / complications
  • Osteoarthritis, Hip / surgery
  • Osteopathic Medicine / methods*
  • Palpation
  • Physical Examination
  • Preoperative Care / methods*
  • Scoliosis / complications
  • Scoliosis / diagnosis*
  • Subarachnoid Space
  • Thoracic Vertebrae


  • Anesthetics