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01-06-2018 | Original Article

Spinal movement and dural sac compression during airway management in a cadaveric model with atlanto-occipital instability

Authors: Shiyao Liao, Niko R. E. Schneider, Frank Weilbacher, Anne Stehr, Stefan Matschke, Paul A. Grützner, Erik Popp, Michael Kreinest

Published in: European Spine Journal | Issue 6/2018

Abstract

Purpose

To analyze the compression of the dural sac and the cervical spinal movement during performing different airway interventions in case of atlanto-occipital dislocation.

Methods

In six fresh cadavers, atlanto-occipital dislocation was performed by distracting the opened atlanto-occipital joint capsule and sectioning the tectorial membrane. Airway management was done using three airway devices (direct laryngoscopy, video laryngoscopy, and insertion of a laryngeal tube). The change of dural sac’s width and intervertebral angulation in stable and unstable atlanto-occipital conditions were recorded by video fluoroscopy with myelography. Three-dimensional overall movement of cervical spine was measured in a wireless human motion track system.

Results

Compared with a mean dural sac compression of − 0.5 mm (− 0.7 to − 0.3 mm) in stable condition, direct laryngoscopy caused an increased dural sac compression of − 1.6 mm (− 1.9 to − 0.6 mm, p = 0.028) in the unstable atlanto-occipital condition. No increased compression on dural sac was found using video laryngoscopy or the laryngeal tube. Moreover, direct laryngoscopy caused greater overall extension and rotation of cervical spine than laryngeal tube insertion in both stable and unstable conditions. Among three procedures, the insertion of a laryngeal tube took the shortest time.

Conclusion

In case of atlanto-occipital dislocation, intubation using direct laryngoscopy exacerbates dural sac compression and may cause damage to the spinal cord.

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Title: Spinal movement and dural sac compression during airway management in a cadaveric model with atlanto-occipital instability
Authors: Shiyao Liao
Niko R. E. Schneider
Frank Weilbacher
Anne Stehr
Stefan Matschke
Paul A. Grützner
Erik Popp
Michael Kreinest
Publication date: 01-06-2018
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 6/2018
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-017-5416-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Spinal movement and dural sac compression during airway management in a cadaveric model with atlanto-occipital instability

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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