Effect of surgical cricothyrotomy on the unstable cervical spine in a cadaver model of intubation

Cricothyrotomy is indicated for patients who require an immediate airway an d in whom orotracheal or nasotracheal intubation is unsuccessful or contrai ndicated. Cricothyrotomy is considered safe with cervical spine (spine) inj ury; however, the amount of c-spine movement that occurs during the procedu re has not been determined. In this experimental study, an established cada ver model of c-spine injury was used to quantify movement during crothyroto my. A complete C5-6 transection was performed by using an osteotome on 13 f resh-frozen cadavers, Standard open cricothyrotomy,vas performed on each ca daver, with c-spine images recorded in real time on fluoroscopy, then trans ferred to video and Kodachrome still images. Outcome measures included move ment across the C5-6 site with regard to angulation expressed in degrees of rotation and linear measures of axial distraction and anterior-posterior ( AP) displacement expressed as a proportion of C5 body width. Data were anal yzed by using descriptive statistics to determine mean change from baseline in each of three planes of movement. Significance was assumed if 95 % conf idence intervals did not include zero. A significant amount of movement was observed with regard to AP displacement (6.3% of C5 width) and axial distr action (-4.5% of C5 width, indicating narrowing of the intervertebral space ), These correspond to 1-2 mm AP displacement and less than 1 mm axial comp ression, No significant angular displacement was observed. In conclusion, c ricothyrotomy results in a small but significant amount of movement across an unstable c-spine injury in a cadaver model, This degree of movement is l ess than the threshold for clinical significance, (C) 2001 Elsevier Science Inc.