AIrway Challenges in a Ankylosing Spondylitic Patient Withtraumatic Cervical Spine Fracture - A Case Report

Background:Ankylosing Spondylitis (AS) is a chronic inflammatory condition that results in the fusion of the spine and decreased flexibility, commonly known as bamboo spine. This condition presents significant challenges to anesthesiologists due to potential difficulties in managing the airway, cardiovascular issues, and compromised respiration. AS patients face an increased risk of fractures and spinal cord injury, especially in the cervical spine, which is prone to instability and higher morbidity and mortality rates. Maneuvers to manage the airway and intubation techniques may exacerbate movement in the cervical spine, potentially leading to further injury. Case Report: A 42-year-old man with a history of AS presented with a cervical spine injury after a road traffic accident. MRI showed fractures at the posterior arch of C1 and C4-C5 levels with nerve root compression. The patient, who was not regularly followed up, was taking medication. Preoperative assessment revealed a potentially difficult airway, and the patient had quadriparesis and reduced sensation. Due to the risk of spinal cord injury, an awake fiberoptic intubation (AFOI) was planned. The AFOI was successfully performed through the nasal route, and the patient underwent a C4-C5 discectomy and stabilization. The postoperative recovery was uneventful, with no new neurological deficits. Discussion: The case emphasizes the need to minimize movement of the cervical spine when managing the airway in AS patients with cervical spine fractures. Using AFOI is more effective than other techniques in this scenario, as it minimizes cervical movement and allows for post-intubation neurologic assessments. Although the glidescope video laryngoscope and intubating laryngeal mask airway are considered as alternatives to direct laryngoscopy, anesthesiologists still prefer AFOI as the primary option. Conclusion: This case report demonstrates the best airway management for an AS patient with a cervical spine fracture, with a focus on the role of the anesthesiologist in preventing further injury and neurologic deterioration. Awake fiberoptic intubation is the safest alternative for AS patients with cervical spine fractures, as long as the anesthesiologist has the requisite skills and knowledge.