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Cervical Myelopathy Airway Management — FRCA Final MCQ

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HardAirway ManagementCervical Myelopathy Airway ManagementFRCA Final

A 60-year-old woman (ASA III) with rheumatoid arthritis and cervical myelopathy (C3/4 cord compression on MRI) requires a total knee replacement. She has upper and lower limb hyperreflexia and an unsteady gait. Which airway management approach is most appropriate?

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Correct answer: A — Standard rapid sequence induction with neck extension for direct laryngoscopy

In a patient with cervical myelopathy from C3/4 cord compression, any neck movement (flexion or extension) during laryngoscopy risks worsening spinal cord compression and causing quadriplegia. Awake fibreoptic intubation is the safest approach as it: maintains the patient's own muscle tone (splinting the spine), avoids the need for neck extension, preserves neurological function for continuous monitoring during the procedure, and allows neurological assessment before and immediately after intubation. This patient should be discussed with the neurosurgical team pre-operatively regarding the stability and clinical significance of the cervical lesion.

Reference: DAS – 2025 – Difficult intubation; RCOA – 2023 – Cervical spine and anaesthesia