Segmental cervical spine motion during orotracheal intubation of the intact and injured spine with and without external stabilization

Object. The purpose of this study was to establish a cadaveric model for ev aluating cervical spine motion in both the intact and injured states and to examine the efficacy of commonly used stabilization techniques in limiting that motion. Methods. Intubation was performed in fresh human cadavers with intact cervi cal spines, following the creation of a C4-5 posterior ligamentous injury. Movement of the cervical spine during direct laryngoscopy and intubation wa s recorded using video fluoroscopy and examined under the following conditi ons: 1) without external stabilization; 2) with manual in-line cervical imm obilization; and 3) with Gardner-Wells traction. Subsequently, segmental mo tion of the occiput through C-5 (Oc-C5) was measured from digitized frames of the recorded video fluoroscopy. The predominant motion, at all levels measured in the intact spine, was ext ension. The greatest degree of motion occurred at the atlantooccipital (Oc- C1) junction, followed by the C1-2 junction, with progressively less motion at each more caudal level. After posterior destabilization was induced, th e predominant direction of motion at C4-5 changed from extension to flexion , but the degree of motion remained among the least of all levels measured. Traction limited but did not prevent motion at the Oc-C1 junction, but nei ther traction nor immobilization limited motion at the destabilized C4-5 le vel. Conclusions. Cadaveric cervical spine motion accurately reflected previousl y reported motion in living, anesthetized patients. Traction was the most e ffective method of reducing motion at the occipitocervical junction, but no ne of the interventions significantly reduced movement at the subaxial site of injury. These findings should be considered when treating injured patie nts requiring orotracheal intubation.