High-flow nasal oxygen with flexible channel oxygen insufflation for ankylosing spondylitis and cervical fracture-dislocation: a case report and literature review

Ankylosing spondylitis predisposes patients to cervical fracture and spinal cord injury after minor trauma. Tracheal intubation must therefore be performed with minimal cervical motion to avoid iatrogenic neurological damage, a challenge for the anaesthetist. A 41-year-old man with ankylosing spondylitis sustained a traumatic fracture of the seventh cervical spine, with displacement and spinal cord compression. After thorough airway assessment, he received high-flow nasal oxygen to maintain oxygenation, combined with oxygen insufflation through the flexible working channel. Following induction of general anaesthesia and muscle relaxation, a fibrescope was advanced into the trachea without cervical spine movement, and intubation was successfully completed. In the present case, combining high-flow nasal oxygen with oxygen insufflation through the flexible working channel permits flexible intubation while avoiding cervical motion and securing the airway safely.