Airway management in cervical spine injured patients

Cervical spine injury (CSI) creates a special problem in airway management. The cervical spine is comprised of seven vertebrae that are uniquely configured and house the spinal cord at the center. The configuration of the cervical spine allows specific movements of the head and neck in a limited fashion. Cervical instability is a serious concern and occurs when movement in the spine is greater than normal, possibly placing the spinal cord at risk. Spinal cord injury is the primary concern when considering CSI, and can occur in a number of scenarios and pathologies, the most worrisome of which are direct injury and spinal cord compression. Evaluation and initial management of CSI should include radiographic assessment in patients at particular risk, early cervical immobilization, and potentially elective intubation. Recognition of CSI in association with other traumatic injuries is critical. When approaching the airway of a CSI patient, recognition of injury and timely intubation are critical. Direct laryngoscopy with manual in-line stabilization (MILS) is the most commonly practiced technique and is considered safe; other options for intubation include flexible fiberoptic intubation, video laryngoscopy, laryngeal mask airway (LMA) use, and nasal intubation. Regardless of the modality used, airway management must be conducted with regard for securing the airway as quickly and safely as possible while maintaining cervical immobilization.