The correlation of cervical symptoms with endotracheal intubation quality and preoperative airway assessment with radiological methods: A prospective observational study

Airway management can be challenging for patients undergoing cervical spinal surgery. This study aimed to evaluate how the duration of the cervical pathology associated with neck pain and numbness affects airway anatomy and airway management, and to correlate radiological measurements. This was a single-center prospective observational study. Eighty-two patients with American Society of Anesthesiologists I to III were selected from those undergoing surgery for cervical pathology. The patients' symptoms and duration of cervical disease were assessed. Skin-epiglottis, skin-hyoid, epiglottis-vocal cord, and hyomental distance measurements were performed using ultrasonography. The bilateral multifidus and longus colli muscles, presence of prevertebral fluid, thickening of the prevertebral soft tissue, increase in muscle signal intensity, pre-epiglottic depth of field, distance between the vocal cords, and epiglottis were evaluated using magnetic resonance imaging. Patients were intubated using a videolaryngoscope. Intubation times, the percentage of glottic opening, the number of intubation attempts, and complications were recorded during intubation. Intubation quality was evaluated based on intubation time, number of attempts, and the percentage of glottic opening achieved during videolaryngoscopy. The correlation between symptom duration and intubation quality was assessed. Radiological measurements of the airway were compared with the symptom duration. Symptom duration did not affect intubation parameters (P > .05). Skin-hyoid distance showed a positive correlation with pain duration (r = 0.410, P = .001) and numbness duration (r = 0.452, P < .001). The depth of the pre-epiglottic space increased with the duration of numbness (r = 0.325, P = .034). Epiglottis-vocal cord distance correlated with intubation time (r = 0.297, P = .026). Our study is significant in that it focuses on analyzing preoperative airway evaluation through radiological data and comparing these findings to the quality of intubation achieved with videolaryngoscopy. Radiological measurements such as skin-hyoid distance and pre-epiglottic space depth demonstrated measurable correlations with symptom duration, suggesting potential value in preoperative airway assessment. However, these anatomical variations did not significantly influence intubation performance when videolaryngoscopy was used.