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. 2014 Jan;4(1):50-6.
doi: 10.4103/2229-5151.128013.

Airway management in cervical spine injury

Naola Austin  1 , Vijay Krishnamoorthy  1 , Arman Dagal  1
Affiliations

Airway management in cervical spine injury

Naola Austin et al. Int J Crit Illn Inj Sci. 2014 Jan.

Abstract

To minimize risk of spinal cord injury, airway management providers must understand the anatomic and functional relationship between the airway, cervical column, and spinal cord. Patients with known or suspected cervical spine injury may require emergent intubation for airway protection and ventilatory support or elective intubation for surgery with or without rigid neck stabilization (i.e., halo). To provide safe and efficient care in these patients, practitioners must identify high-risk patients, be comfortable with available methods of airway adjuncts, and know how airway maneuvers, neck stabilization, and positioning affect the cervical spine. This review discusses the risks and benefits of various airway management strategies as well as specific concerns that affect patients with known or suspected cervical spine injury.

Keywords: Anesthesia; intubation; spinal cord injury; trauma.

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Conflict of interest statement

Conflict of Interest: No.

Figures

Figure 1
Figure 1
Cervical Spine Anatomy. (a) Lateral view of seven cervical vertebra, laminae and pedicles removed to show spinal cord space (gray), (b) Ligaments forming the anterior and posterior columns shown in lateral cross section, ALL: Anterior longitudinal ligament, PLL: Posterior longitudinal ligament, LF: Ligamentum flavum, ISL: Interspinous ligament, SSL: Supraspinous ligament, (c) Superior view of first on second cervical vertebra and the transverse ligament (TL), which normally limits translation and the atlas-dens interval (ADI)
Figure 2
Figure 2
The Poisson Effect Applied to the Cervical Spine (a) During neck flexion, the axis of the cervical spine is the vertebral bodies, so both the spinal cord and space available for the spinal cord are stretched and narrowed (gray hatch marks), (b) During neck extension, both the spinal cord and space available for the spinal cord are compressed and widened
Figure 3
Figure 3
Cervical Spine Injury Types (a) Hyperflexion leading a vertebral body wedge fracture, (b) Hyperflexion leading to a “Jefferson” fracture of C1 anterior and posterior arches, (c) Hyperflexion leading to “Hangman's” fracture of C2 pedicles, (d) Compression injuries leading to a vertebral body burst fractures and retropulsed bone fragments
Figure 4
Figure 4
Neck Maneuvers During Airway Management. (a) Neck stabilization using sandbag-collar-tape on hardboard for pre-hospital care, (b) Cricoid pressure application with anterior half of hard cervical collar removed and other hand behind posterior cervical collar, (c) Manual in-line stabilization from the head of bed, with anterior cervical collar removed and hands cradling occiput and mastoid process, (d) Manual in-line stabilization from side of bed to facilitate airway intervention from head of bed
See this image and copyright information in PMC

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