Anest. intenziv. Med. 2026;37(1):36-39 | DOI: 10.36290/aim.2026.007

Lumbar spinal stenosis - a strong reminder to monitor neurological status after surgeryCase Report

Horáček M.^{1, 2}

¹ Klinika anesteziologie, resuscitace a intenzivní medicíny, 2. lékařská fakulta Univerzity Karlovy, Praha

² Katedra anesteziologie a intenzivní medicíny, Institut postgraduálního vzdělávání ve zdravotnictví, Praha

Lumbar spinal stenosis (LSS, M48.06) is a common degenerative disease of the spine, the incidence of which increases significantly with age. It can be a serious risk factor when performing central nerve blocks. Central blocks, especially spinal anaesthesia, are considered the method of choice for many orthopaedic procedures, including total knee replacement. However, their use in patients with lumbar spinal stenosis requires increased caution. It is documented by a case study described in the judgment of the Supreme Court of the Czech Republic. The patient developed a severe and permanent neurological deficit due to decompensated multi-level lumbar spinal stenosis after total knee replacement performed under general anaesthesia following a failed epidural anaesthesia. The case is presented from both a clinical and legal perspective. Possible pathophysiological mechanisms of neurological damage, in particular the role of volume effect in the narrowed spinal canal, perfusion deficits of nerve structures, and the importance of early diagnosis are discussed. The case emphasizes the need for careful preoperative assessment, thorough postoperative monitoring of neurological functions, and immediate treatment of newly emerging neurological symptoms. For patient safety, lumbar spinal stenosis should prompt at least increased vigilance. Therefore, in some patients, modern general anaesthesia with multimodal analgesia and peripheral nerve blocks may also be a suitable option.

Keywords: lumbar spinal stenosis, epidural anaesthesia, spinal anaesthesia, cauda equina syndrome, conus medullaris syndrome, standard of care (lege artis).

Received: January 9, 2026; Revised: February 23, 2026; Accepted: March 10, 2026; Prepublished online: March 27, 2026; Published: April 9, 2026  Show citation