Airway Management after Cervical Spine Surgery
Updated Sept 2022
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For all intubated patients with acute ASIA A-C cervical spinal cord injuries or upper thoracic spinal cord injuries with concomitant chest wall injuries, please contact the on-call intensivist prior to extubation for disposition planning
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When planning extubation in any patient following cervical spine surgery (independent of acute spinal cord injury) consider the following algorithm:
Are there two or more risk factors for post operative airway complications?
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Combined anterior posterior approach
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C1 or C2 levels involved
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Difficult or traumatic intubation
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Estimated Blood loss >300 mls
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Pre-existing myelopathy
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Pre-existing pulmonary disease
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Prolonged operative time >5 hours
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Surgery involving 3 vertebral levels including one C4 or above
If yes, consider:
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Delayed extubation
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Extubation with close monitoring in a critical care setting
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Extubation over an airway exchange catheter
