Catastrophic neurological complications of emergent endotracheal intubation: Report of 2 cases

Mark E. Oppenlander, Forrest D. Hsu, Patrick Bolton, Nicholas Theodore

Research output: Contribution to journalArticle

Abstract

Although exceedingly rare, catastrophic neurological decline may result from endotracheal intubation of patients with preexisting cervical spine disease. The authors report on 2 cases of quadriplegia resulting from emergent endotracheal intubation in the intensive care unit. A 68-year-old man with ankylosing spondylitis became quadriplegic after emergent intubation. A new C6-7 fracture-dislocation was identified, and the patient underwent emergent open reduction and C4-T2 posterior fixation and fusion. The patient remained quadriplegic and ultimately died of pneumonia 1 year later. This is the first report with radiographic documentation of a cervical fracture-dislocation resulting from intubation in a patient with ankylosing spondylitis. A 73-year-old man underwent posterior C6-T1 decompression and fixation for a C6-7 fracture. On postoperative Day 12, emergent intubation for respiratory distress resulted in C6-level quadriplegia. Imaging revealed acute spondyloptosis at C6-7, and the patient underwent emergent open reduction with revision and extension of posterior fusion from C-3 to T-2. He remained quadriplegic and ventilator dependent. Five days after the second operation, care was withdrawn. This is the first report of intubation as a cause of significant neurological decline related to disruption of a recently fixated cervical fracture. Risk factors are identified and pertinent literature is reviewed for cases of catastrophic neurological complications after emergent endotracheal intubation. Strategies for obtaining airway control in patients with cervical spine pathology are also identified. Awareness of the potential dangers of airway management in patients with cervical spine pathology is critical for all involved subspecialty team members.

Original languageEnglish (US)
Pages (from-to)454-458
Number of pages5
JournalJournal of Neurosurgery: Spine
Volume22
Issue number5
DOIs
StatePublished - May 2015
Externally publishedYes

Keywords

  • Cervical spine
  • Endotracheal intubation
  • Quadriplegia

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

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