Clinical Evaluation and Airway Management for Adults with Cervical Spine Instability

Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care

“…[ 1 ] A plethora of research on different intubation techniques in actual or simulated CSI has been published. [ 2 3 4 5 ] However, current studies largely focus on surrogate outcomes, such as intubation success rate or degree of cervical spine movement versus patient-centric outcomes such as intubation-associated neurological deficits. Further, there are no guidelines provided by societies such as the Difficult Airway Society[ 6 ] or American Society of Anesthesiologists[ 7 ] which address special concerns regarding intubation in patients with CSI.…”

Tracheal intubation in patients at risk for cervical spinal cord injury: A systematic review

“…Instability of the cervical spine can be defined as a clinical condition in which motion or compression of cervical spinal tract can cause a vertebral displacement that jeopardize the spinal cord or the nerve roots. 1,2 Instability is often secondary to a trauma injuring the cervical bony or ligamentous elements; non-traumatic causes are also possible, like congenital syndromes or acquired diseases (above all rheumatoid arthritis and spondyloarthropathies). 2 Traditionally, tracheal intubation in normal subjects includes full extension of the atlanto-occipital and atlanto-axial joints, flexion of the lower cervical spine tract and direct laryngoscopy 3 : any of these factors could injury to the spinal cord if instability is present.…”

“…Studies performed in cadaver models of cervical spine and clinical studies showed that basic and advanced airways maneuvers can be dangerous. 1,2 Semi-rigid collars are commonly used to restrict motion in patients at risk for spinal cord injury: unfortunately, they markedly limit mouth opening to less than 3 cm and removal of their anterior portion can be required during tracheal intubation. 1,3 Manual in-line stabilization (MILS) is considered a better option during intubation, but it could not completely prevent cervical spine movement and result in limited laryngoscopic view and potentially in difficult intubation.…”

“…1,3 Manual in-line stabilization (MILS) is considered a better option during intubation, but it could not completely prevent cervical spine movement and result in limited laryngoscopic view and potentially in difficult intubation. 1,2 Beside direct laryngoscopy, several tracheal intubation techniques (videolaryngoscopy, lighted stylets, fiberoptic stylets, supraglottic devices and awake fiberoptic intubation) have been evaluated in real or simulated cervical spine instability. [1][2][3] We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) comparing two or more tracheal intubation techniques in operating room in adults at risk for secondary cervical spinal cord injury, to identify the best technique in terms of efficacy and safety.…”

Radiological Assessment Of Cervical Spine Mobility Comparing Direct Laryngoscopy With Miller Blade And Video-Laryngoscopy With CMAC In Healthy Adults

“…A reduction in CS movement during OTI is beneficial for these patients because undesirable mobilization can create or worsen a neurological injury [2]. Moreover, patients with cervical instability and acute cardiovascular or airway compromise may require a rapid intubation which should be made in the fewest attempts possible while minimizing cervical mobilization (CM) as much as possible [3].…”