{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T12:05:46Z","timestamp":1789646746404,"version":"4.0.0"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Spontaneous cerebrospinal fluid (CSF) rhinorrhoea undergoing endoscopic endonasal repair often requires intraoperative intrathecal lumbar drain (ITLD) placement for fluorescein-assisted fistula localisation and postoperative CSF diversion. Severe spinal deformity can render conventional landmark and ultrasound-guided neuraxial access impossible. We describe a 45-year-old female with post-polio thoracolumbar scoliosis and vertebral rotation undergoing endoscopic repair of a cribriform plate CSF leak, in whom both landmark and ultrasound-guided ITLD placement failed because of absent acoustic windows. Fluoroscopy revealed an apparent lateral image on the standard antero-posterior projection, reflecting near 90-degree axial vertebral rotation.A patient-specific 30-degree oblique C-arm angulation restored a functional antero-posterior-equivalent view, enabling successful catheter placement after fine-needle confirmation. Fluorescein-guided endoscopic repair was subsequently completed uneventfully, with no neurological or CSF-leak-related complications. This case highlights a reproducible, stepwise rescue algorithm-landmark, ultrasound, and patient-tailored fluoroscopic oblique angulation for safe neuraxial access in severely deformed spine, applicable across diverse difficult neuraxial access scenarios.<\/jats:p>","DOI":"10.4103\/ija.ija_611_26","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T12:00:46Z","timestamp":1789646446000},"page":"1054-1057","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Fluoroscopy-guided intrathecal lumbar drain placement in severe post-polio spinal deformity: A case report"],"prefix":"10.4103","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5184-6490","authenticated-orcid":false,"given":"Shivakumar M.","family":"Channabasappa","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5392-8363","authenticated-orcid":false,"given":"S","family":"Srihari","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0048-1452","authenticated-orcid":false,"given":"S","family":"Kavyashree","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2836-131X","authenticated-orcid":false,"given":"Pooja","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka, 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