Introduction clearing the cervical spine

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The cervical spine has been traditionally divided into an upper segment (skull base, C1 and C2), and a lower segment comprising C3-C7. This is not arbitrary and is actually based on specific embryological, morphological and physiologically distinct differences. The characteristics of these two segments become particularly relevant when considering the effects of traumatic events. The most common level is C2 which accounts for 24% of fractures.

The cervical spine attains an importance to the anaesthetist as proper head position is important for successful orotracheal intubation. The oral, pharyngeal and laryngeal axes must be aligned for direct laryngoscopy. The head needs to be elevated at least 10 cm above the shoulders to align the pharyngeal and laryngeal axes. Also the atlanto-occipital joint needs to be extended to achieve the straightest possible line from the incisors to the glottis [1]. A difficult airway is characterised by a limited range of motion at the cervical spine or temporomandibular joint. It can be encountered in conditions such as diffuse idiopathic skeletal hyperostosis (DISH), ankylosing spondylitis, rheumatoid arthritis, juvenile chronic arthritis, Klippel-Feil

E syndrome (congenital fusion of upper cervical segment) and in the

4 presence of suspected or unknown spinal injury (fracture) in which orotracheal intubation might be contraindicated.

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