Anesthetic challenges in a patient with severe kyphoscoliosis undergoing vaginal hysterectomy with pelvic floor repair: A case report

Severe kyphoscoliosis poses significant anesthetic challenges due to distorted spinal anatomy and associated restrictive pulmonary physiology. Neuraxial anesthesia in such patients is technically demanding and may produce unpredictable block characteristics; however, it avoids airway manipulation and may reduce perioperative respiratory complications. We report the successful use of combined spinal–epidural anesthesia in a 48-year-old woman with severe thoracolumbar kyphoscoliosis and restrictive lung disease undergoing vaginal hysterectomy with pelvic floor repair. Technical modifications, positioning strategies to control block spread, and perioperative management are described. This case highlights that with careful planning and execution, combined neuraxial techniques can be a safe and effective alternative to general anesthesia in selected patients with severe spinal deformity.