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Cervical spine mobility is central to the conventional safe management of the airway. Acquired causes are mainly degenerative diseases (osteoarthritis, degenerative disc disease), inflammatory processes (rheumatoid arthritis, ankylosing spondylitis), trauma, and prior surgical fusion. This chapter presents a case study of a 68-year-old male with severe ankylosing spondylitis who sustained a fracture through the C6 vertebral body following a fall. The patient was positioned in the prone position with care taken to avoid cervical spine extension and to preserve the alignment of the cervico-thoracic spine, to the extent that was possible given the underlying deformity. The blood pressure was maintained at preinduction values at all times. The patient presented in this case demonstrated several of the features that predict difficulty in airway management. Awake flexible fiberoptic intubation is considered to be the gold standard in this challenging patient group.
Each year in the USA there are approximately 10000 new cases of spinal injury and the cervical spine is most commonly affected. This chapter presents a case study of a 27-year-old male who was immobilized on a spinal board, with rigid cervical collar. The anterior portion of the cervical collar was removed, manual in-line stabilization (MILS) maintained and cricoid pressure was applied. The immobilization of the spine in trauma patients until injuries have either been excluded or definitively treated remains a cornerstone of modern trauma care. The anesthesia provider must maintain the mechanical integrity of the spinal cord by limiting neck movement, as well as ensure adequate spinal cord perfusion by avoiding hypotension and subsequent tissue hypoxia. The degree of movement and angulation in spinal segments with any of these intubation techniques is of uncertain clinical significance.
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