Cervical spinal motion during intubation: efficacy of stabilization maneuvers in the setting of complete segmental instability

Object. The purpose of this study was to characterize and compare segmental cervical motion during orotracheal intubation in cadavers with and without a complete subaxial injury, as well as to examine the efficacy of commonly used stabilization techniques in limiting that motion. Methods. Intubation procedures were performed in 10 fresh human cadavers in which cervical spines were intact and following the creation of a complete C4-5 ligamentous injury. Movement of the cervical spine during direct lary ngoscopy and intubation was recorded using video fluoroscopy and examined u nder the following conditions: 1) without stabilization; 2) with manual in- line cervical immobilization: and 3) with Gardner-Wells traction. Subsequen tly, segmental angular rotation, subluxation, and distraction at the injure d C4-5 level were measured from digitized frames of the recorded video fluo roscopy. Conclusions: After complete C4-5 destabilization, the effects of attempted stabilization on distraction, angulation, and subluxarion were analyzed. Im mobilization effectively eliminated distraction, and diminished angulation, but increased subluxation. Traction significantly increased distraction, b ut decreased angular rotation and effectively eliminated subluxation. Orotr acheal intubation without stabilization had intermediate results, causing l ess distraction than traction, less subluxation than immobilization, but in creased angulation compared with either intervention. These results are discussed in terms of both statistical and clinical signi ficance and recommendations are made.