Intubation biomechanics: validation of a finite element model of cervical spine motion during endotracheal intubation in intact and injured conditions.

Abstract

OBJECTIVE Because of limitations inherent to cadaver models of endotracheal intubation, the authors' group developed a finite element (FE) model of the human cervical spine and spinal cord. Their aims were to 1) compare FE model predictions of intervertebral motion during intubation with intervertebral motion measured in patients with intact cervical spines and in cadavers with spine injuries at C-2 and C3-4 and 2) estimate spinal cord strains during intubation under these conditions. METHODS The FE model was designed to replicate the properties of an intact (stable) spine in patients, C-2 injury (Type II odontoid fracture), and a severe C3-4 distractive-flexion injury from prior cadaver studies. The authors recorded the laryngoscope force values from 2 different laryngoscopes (Macintosh, high intubation force; Airtraq, low intubation force) used during the patient and cadaver intubation studies. FE-modeled motion was compared with experimentally measured motion, and corresponding cord strain values were calculated. RESULTS FE model predictions of intact intervertebral motions were comparable to motions measured in patients and in cadavers at occiput-C2. In intact subaxial segments, the FE model more closely predicted patient intervertebral motions than did cadavers. With C-2 injury, FE-predicted motions did not differ from cadaver measurements. With C3-4 injury, however, the FE model predicted greater motions than were measured in cadavers. FE model cord strains during intubation were greater for the Macintosh laryngoscope than the Airtraq laryngoscope but were comparable among the 3 conditions (intact, C-2 injury, and C3-4 injury). CONCLUSIONS The FE model is comparable to patients and cadaver models in estimating occiput-C2 motion during intubation in both intact and injured conditions. The FE model may be superior to cadavers in predicting motions of subaxial segments in intact and injured conditions.