A case of difficult tracheal intubation of a cervical spondylotic myelopathy patient with a history of occipitocervical fusion

Abstract

We report a case of a 57-year-old woman who previously underwent occipitocervical fusion (O-C4) at the age of 37 for subluxation of the atlantoaxial subluxation due to rheumatoid arthritis. She was found to have a loss of fine motion skills in the hand and gait disturbance due to myelopathy caused by adjacent segment disease, and was referred for surgery. The patient was transferred to our hospital due to tracheal intubation difficulties at the previous hospital. The operation was postponed again because the epiglottis could not be confirmed by endoscopic intubation. One month later, we could finally complete the operation by conscious nasal intubation. The initial surgery was performed in the flexed position. Airway narrowing due to pharyngeal edema was thought to be the cause of the intubation difficulty.