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

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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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Acknowledgements

The authors wish to thank Y. Chen and Z. Zhou for helping us in developing cadaveric models. We want to thank S. Doll and S. Weißenmayer for their assistance with the preparation of this study.

Author information

Author notes

  1. Shiyao Liao and Niko R. E. Schneider contributed equally to the current work.

Authors and Affiliations

  1. Department of Trauma Surgery and Orthopaedics, Spine Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany

    Shiyao Liao, Stefan Matschke, Paul A. Grützner & Michael Kreinest

  2. Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany

    Niko R. E. Schneider, Frank Weilbacher, Anne Stehr & Erik Popp

Authors
  1. Shiyao Liao
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  2. Niko R. E. Schneider
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Contributions

Conception and designed the experiments: SL, NS, FW, SM, EP, and MK. Performed the experiments: SL, NS, FW, AS, and MK. Analyzed the data: SL, NS, EP, and MK. Wrote the paper: SL, NS, and MK. Supervision and support: SM, PG, EP, and MK. Reviewed and revised the submitted version of manuscript: SL, NS, FW, AS, SM, PG, EP, and MK.

Corresponding author

Correspondence to Michael Kreinest.

Ethics declarations

Ethical standards

The study was approved by Ethics committee of the State Medical Association Rhineland-Palatinate, Germany (Registry No. 837.156.16) and was registered in the German Clinical Trials Register (ID: DRKS00010499). All procedures performed in this study involving cadavers were in accordance with the law requirements and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflicts of interest.

Source of funding

There was no funding on this study.

Informed consent

The fresh cadavers were recruited from the local body donation program. The informed consent was obtained from all body donors included in the study.

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Liao, S., Schneider, N.R.E., Weilbacher, F. et al. Spinal movement and dural sac compression during airway management in a cadaveric model with atlanto-occipital instability. Eur Spine J 27, 1295–1302 (2018). https://doi.org/10.1007/s00586-017-5416-9

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  • DOI: https://doi.org/10.1007/s00586-017-5416-9

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