• Arnaud Robitaille.
• Département d'Anesthésiologie, Centre Hospitalier de l'Université de Montréal, Pavillon Notre-Dame, 1560 Sherbrooke Est, Montreal, QC H2L 4M1, Canada. arnaud.robitaille@umontreal.ca
• Can J Anaesth. 2011 Dec 1;58(12):1125-39.

PurposeSecuring the airway of a patient with a potentially unstable cervical spine (C-spine) is a complex and challenging task. The objective of this continuing professional development module is to review the current knowledge essential for airway management in the face of potential C-spine instability and, at the same time, to underline areas of uncertainty and limitations in the literature.Principal FindingsIn low-risk patients-defined by strict criteria derived from large multicentre studies-the C-spine can be considered stable or "cleared" without imaging. In all other patients, at least a thin-section computed tomographic examination of the spine from the occiput to T1 should be obtained, including sagittal and coronal multiplanar reconstructed images. Until the C-spine is cleared, it should be immobilized in the neutral position using a rigid cervical collar, sandbags, tape, and a backboard. During airway management, the anterior part of the cervical collar should be removed, and manual in-line stabilization should be applied. Some airway techniques, such as fibreoptic bronchoscopy and the Trachlight(®), have been shown to induce less C-spine movement than direct laryngoscopy; however, the impact of such airway management on outcome is uncertain.ConclusionAdequate airway management in the patient with potential C-spine injury demands an understanding of C-spine anatomy, the criteria required to clear the C-spine, and the indications, techniques, and pitfalls of C-spine immobilization. When choosing an airway technique, minimization of C-spine motion should be considered, but the method of choice should also incorporate the broader clinical context.

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