Cervical Spinal Injury Research Articles

143. Evolution of patient-reported outcome measures beyond one-years after fixation surgery for subaxial cervical spine injuries

143. Evolution of patient-reported outcome measures beyond one-years after fixation surgery for subaxial cervical spine injuries

Cerebrolysin recovers diaphragmatic function and reduces injury-associated astrogliosis following a cervical spinal cord hemi-section injury in rats

BackgroundSpinal cord injury (SCI) is widely considered the most disastrous medical condition. With no available treatment to date, SCI continues to cause disabilities to the patients and affect their own and their caregivers' quality of life. Cerebrolysin (CBL) is a neuropeptide preparation derived from purified brain proteins with suggested neuroprotective and neurotrophic properties. CBL showed earlier the ability to target multiple pathways that helped in the improvement of the recovery following different groups of neurological diseases and injuries, including ischemic stroke, traumatic brain injuries, and even neurodegenerative diseases. In the current study, the neuroprotective effect of CBL following a SCI is called into question using a rat model of spinal cord cervical hemi-section validated earlier by our lab and others. Using 32 rats divided into four groups randomly, CBL treatment was implemented for either 7 or 21 days duration, following the cervical spinal cord hemi-section.ResultsFollowing the CBL treatment, rats with cervical cord hemi-section showed functional improvement of diaphragmatic muscle as recorded by electromyography (EMG). In addition, the histopathological assessment of the spinal cord showed improved neuronal viability and reduced astrogliosis at the site of the injury compared to the non-treated group. 21-day treatment showed significant improvement when compared to the shorter 7-day regimen.ConclusionOur data suggest that CBL is capable of protecting and regenerating anterior horn motor neurons with functional recovery of diaphragmatic muscle functions in rats, suggesting the potential use of CBL for future regenerative and neuroprotective therapy following SCI.

Comparison of Tracheal Intubation Using King Vision (Non-channeled Blade) and Tuoren Video Laryngoscopes in Patients With Cervical Spine Immobilization by Manual In-Line Stabilization: A Randomized Clinical Trial.

Glottic visualization on cervical immobilization with manual in-line stabilization (MILS) might be challenging in individuals with cervical spine injuries. We compared non-channeled King Vision video laryngoscope (VL) (Ambu GmbH, Bad Nauheim, Germany) with Tuoren video laryngoscope (Henan Tuoren Medical Device, Zhengzhou, China) for endotracheal intubation in patients with cervical spine immobilization. A total of 124 patients undergoing elective surgery under general anesthesia were included in this study. After induction of general anesthesia, patients were randomized into two groups (62 each): group K (non-channeled blade of King Vision video laryngoscope) and group T (Tuoren video laryngoscope). Cervical spine immobilization was achieved with manual in-line stabilization. The success of the first pass intubation, the time required to intubate, glottic visualization, and intubation difficulty score (IDS) were recorded. The first-attempt success rate of intubation was 95.2% (59 out of 62 patients) in group K and 90.3% (56 out of 62 patients) in group T, which were comparable. The mean glottic visualization time was significantly less with group T (12.74 ± 6.32 seconds) compared to group K (17.92 ± 4.24 seconds). Intubation time was significantly faster with group K (18.79 ± 5.857 seconds) compared to group T (27.21 ± 8.514 seconds). Both video laryngoscopes provided good grades of glottic visualization. We conclude that the performance of the Tuoren video laryngoscope is similar to the King Vision video laryngoscope in terms of first-attempt intubation success rate and glottic visualization score in patients with cervical spine immobilization by manual in-line stabilization. Although glottic visualization time was shorter with Tuoren VL, we could achieve faster intubationwith King Vision VL.

A Retrospective Analysis of the Clinical Use and Utility of Advanced Imaging in the Evaluation of Near-Hanging and Strangulation Injuries at a Canadian Level One Trauma Centre

IntroductionComputed tomography (CT) of the neck is highly sensitive and may effectively rule-out cervical spine, cerebrovascular, and aerodigestive injuries after blunt and penetrating trauma. However, CT may be overutilized in the evaluation of hanging or strangulation injuries. The objective of this study was to determine the diagnostic yield of CT imaging among patients evaluated for hanging or strangulation mechanisms at a Canadian level-1 trauma center. MethodsAll adult patients evaluated for hanging or strangulation injuries over an eight-year period were reviewed. The primary outcome was the diagnostic yield of CT imaging for major aerodigestive, cervical spine, cerebrovascular, or neurological injuries. Multiple logistic regression were performed to determine predictive factors for the use of CT imaging and the identification of injury on imaging. ResultsAmong 124 patients evaluated for hanging or strangulation injuries during the study period, 101 (80%) were evaluated with CT of the head or neck. A total of 26 injuries were identified in 21 patients (18 anoxic brain injuries, 4 aerodigestive, 3 cerebrovascular, and 1 of cervical spine injury). The overall diagnostic yield of neck CT for cervical injuries was 7.8%, 4.7% for laryngeal-tracheal injuries, 3.5% for carotid and vertebral artery injuries, and 1.1% for cervical spine injury. The diagnostic yield of CT head for anoxic brain injury was 22.8%. Factors predicting the use of CT imaging were abnormal physical exam findings (RR 1.7 95% CI [1.2, 2.3]) and transfer accepted by the trauma team leader (RR 1.3 95% CI [1.1, 1.5]). ConclusionCT imaging is often used in the evaluation of patients presenting with hanging or strangulation mechanisms. Seven cerebrovascular, aerodigestive, or cervical spine injuries were identified on imaging during the study period, representing a diagnostic yield of 7%. No injuries were identified among patient with a normal GCS or physical exam. Factors predicting the use of CT imaging included transfer accepted by the trauma team leader and abnormal physical exam findings. The variable clinical presentation of near-hanging and strangulation injuries and the relatively low diagnostic yield of CT imaging should prompt the development of tools and institutional protocols to guide the evaluation of hanging and strangulation injuries.

The diagnostic potential of cone beam computed tomography for cervical spine injuries in children: a review of two reports

Compared to multiaxial computed tomography, the cone beam computed tomography has its benefits in terms of higher resolution imaging, including the construction of a 3D image, and in terms of several fold lower radiation exposure. The duration of scanning of less than 1 minute and the possibility to place a patient in the sitting position allow for the use of this method in various fields of stomatology, maxillofacial surgery, as well as in traumatology for the assessment of limb injuries.
 The paper presents our experience with the cone beam computed tomography as a single method for radiation diagnostics in children with cervical spine injuries. The first case is an example of the use of this method for primary diagnosis and subsequent follow-up of the restoration of the atlantoaxial position in a 9-year old child with rotatory subluxation of the atlant. To clarify the type of the injury, we combined and compared the axial planes of the 1st and 2nd cervical vertebrae. In the second case, we explored the possibility to assess the restoration of the bone structure and mutual position of the upper cervical vertebrae with the images obtained by cone beam computed tomography in a 9-year old girl with the Down's syndrome, who had been operated due to a cervical spine injury.
 The analysis of the cone beam computed tomography images from the first clinical case delineates the prospects of the method in the diagnostics of the atlant rotation subluxation in school-age children. Evaluation of the images obtained during the examination of the second clinical case has identified some disadvantages of the cone beam computed tomography, namely: 1) there is no way to control the fixed patient position, 2) limitations of the software to suppress artifacts arising from the metal construction, which leads to advanced image blurring and flatness, significantly hindering the identification of abnormalities.

Dental and Dentoalveolar Injuries in the Pediatric Patient.

Dental and dentoalveolar injuries are common in the pediatric population. Management is predicated on the type of tooth injured (primary or permanent), extent of injury, the dental and behavioral age of the patient, and ability of the patient to tolerate treatment. Although many dental injuries occur in isolation, a systematic evaluation of the patient is mandatory to confirm the absence of basal bone fractures of the maxilla or mandible, traumatic brain injury, cervical spine injury, and/or facial soft tissue injury. Long-term follow-up is paramount to achieving a functional occlusion and optimal dental health following injury.

Timing of Surgery and Pre-operative Physiological Parameters as Clinical Predictors of Surgical Outcomes in Traumatic Subaxial Cervical Spine Fractures and Dislocations.

Objective To evaluate the risk factors and outcomes in patients surgically treated for subaxial cervical spine injuries with respect of the timing of surgery and preoperative physiological parameters of the patient. Methods 26 patients with sub-axial cervical spine fractures and dislocations were enrolled. Demographic data of patients, appropriate radiological investigation, and physiological parameters like respiratory rate, blood pressure, heart rate, PaO2 and ASIA impairment scale were documented. They were divided pre-operatively into 2 groups. Group U with patients having abnormal physiological parameters and Group S including patients having physiological parameters within normal range. They were further subdivided into early and late groups according to the timing of surgery as U early , U late, S early and S late . All the patients were called for follow-up at 1, 6 and 12 months. Results 56 percent of patients in Group S had neurological improvement by one ASIA grade and a good outcome irrespective of the timing of surgery. Patients in Group U having unstable physiological parameters and undergoing early surgical intervention had poor outcomes. Conclusion This study concludes that early surgical intervention in physiologically unstable patients had a strong association as a risk factor in the final outcome of the patients in terms of mortality and morbidity. Also, no positive association of improvement in physiologically stable patients with respect to the timing of surgery could be established.

A comparative study to evaluate the cervical spine movements during laryngoscopy using Macintosh and Airtraq laryngoscopes.

Intubation with Macintosh requires flexing the lower cervical spine and extending the atlanto-occipital joint to create a "line of sight." Primary aim of study was to compare the extent of cervical spine movement during laryngoscopy using conventional Macintosh laryngoscope and Airtraq. A total of 25 patients of either sex between the age group of 18 and 60 years, having American Society of Anesthesiologists (ASA) physical status of Grade-I and Grade-II, scheduled for elective surgery under image control requiring general anesthesia and intubation were enrolled. A baseline image of the lateral cervical spine including the first four cervical vertebrae was taken by an image intensifier. After administration of general anesthesia, laryngoscopy was first performed using a Macintosh laryngoscope and a second X-ray image of the lateral cervical spine was taken. The second laryngoscopy using a Airtraq laryngoscope was done and the third image of the lateral cervical spine was taken. Angles between occiput and C1; C1 and C2; C2 and C3; C3 and C4; and occiput and C4 were calculated. Atlanto-occipital distance (AOD) was calculated as the distance between occiput and C1. Macintosh showed greater cervical movement as compared with Airtraq but a significant difference in the movement was observed at C2-C3 and C0-C4. Baseline mean AOD was 2.21 ± 1.25 mm, after Macintosh and Airtraq laryngoscopy was found to be 1.13 ± 0.60 and 1.6 ± 0.78 mm, respectively, and was found to be significant (P < 0.05). We conclude that Airtraq allows intubation with less movement of the upper cervical spine makes Airtraq preferred equipment for intubation in patients with a potential cervical spine injury.

Traumatic Cervical spine injury epidemiology: a tertiary care center perspective in Nepal

Background: The epidemiology of traumatic cervical spine injury is not well documented in developing/ underdeveloped countries. There are a few single-centered studies on the epidemiology of cervical spine injury in Nepal. Objectives: This study aimed to explore the epidemiology of traumatic cervical spine injuries presented at Dhulikhel Hospital, Kathmandu University Hospital, Nepal. Methods: This was a retrospective study of individuals with traumatic cervical spine injuries admitted to the Department of Orthopedics from 2015 January to 2021 December. Data collection was done by using the International Spinal Cord Injury core data set (version 2) and International Spinal Cord Injury Spinal Column Injury Basic Data Set (version 1.0). Results: One hundred and forty-four patients were included of which the majority (68.8%) were males. The mean age of the patients was 47.89 ± 17 years. Fall injury was the most common etiology (79.2%). C2 was the most common level injured (28.5%). Patients with ASIA A neurology was 18% and surgical treatment was given to nearly 60%. The patients had a median hospital stay of 9 days (4- 16) and a mortality of 4.2%. Conclusion: There was a male predominance with a recent increase in the female proportion for traumatic cervical spine injury. Fall was the most common etiology with the majority of patients in their 30s and 40s. Surgical treatment is more preferred recently. The mortality rate was relatively low which needs further investigation.

The incidence and characteristics of clinically relevant blunt cerebrovascular injury at an adult level 1 trauma centre: A retrospective cohort study

Introduction Blunt cerebrovascular injuries (BCVIs) are uncommon but associated with ischemic stroke and disability, particularly in younger adults. There is a paucity of literature on the incidence and risk factors for BCVI. The aim of this study was to report the incidence and clinical characteristics of patients diagnosed with BCVI at an adult level 1 trauma centre. Methods This was a registry-based cohort study. The accessible sample was all patients in the Alfred Hospital Trauma Registry (AHTR) who presented from January 2014 to June 2021 and were recorded to have BCVI. The diagnosis of BCVI was confirmed by independent, blinded neuroradiologists prior to study inclusion. Demographics, injury mechanism and associated injuries of patients were extracted from the AHTR and patient medical records. Results There were 20,954 blunt trauma patients in the AHTR during the study period, of which 300 patients were confirmed to have 428 BCVIs. The incidence of BCVI was 1.4% (95%CI: 1.3–1.6). The mortality rate was 14% with a median survival time of 86 h from the time of injury. More men (65%) were diagnosed with BCVI than women and motor vehicle crashes (n = 180; 60%) were the most common mechanism of injury. Younger age, high transfer mechanisms, high injury severity, brain and chest trauma were associated with carotid artery injuries, while vertebral artery injuries were associated with older age, higher presenting GCS and cervical spinal injuries. Conclusion The incidence of BCVI was low. The risk profile for patients with CAIs and VAIs were different. Consistent with the modified Denver criteria, high energy transfer mechanisms and cervical spinal injuries were identified to be high-risk features, but they impacted carotid and vertebral arteries differently. Any trauma involving these mechanisms should trigger investigation for the detection of BCVIs.

Current Concepts in the Treatment of Traumatic C2 Vertebral Fracture : A Literature Review.

The integrity of the high cervical spine, the transition zone from the brainstem to the spinal cord, is crucial for survival and daily life. The region protects the enclosed neurovascular structure and allows a substantial portion of the head motion. Injuries of the high cervical spine are frequent, and the fractures of the C2 vertebra account for approximately 17-25% of acute cervical fractures. We review the two major types of C2 vertebral fractures, odontoid fracture and Hangman's fracture. For both types of fractures, favorable outcomes could be obtained if the delicately selected conservative treatment is performed. In odontoid fractures, as the most common fracture on the C2 vertebrae, anterior screw fixation is considered first for type II fractures, and C1-2 fusion is suggested when nonunion is a concern or occurs. Hangman's fractures are the second most common fracture. Many stable extension type I and II fractures can be treated with external immobilization, whereas the predominant flexion type IIA and III fractures require surgical stabilization. No result proves that either anterior or posterior surgery is superior, and the surgeon should decide on the surgical method after careful consideration according to each clinical situation. This review will briefly describe the basic principles and current treatment concepts of C2 fractures.

Prognosis of Cervical Diffuse Idiopathic Skeletal Hyperostosis-Related Spine Injuries in Elderly Patients: Analyses of Both Fracture and Spinal Cord Injury Without Fracture.

Retrospective multicenter study. The purpose of this study was to compare the prognosis of elderly patients with injuries related to cervical diffuse idiopathic skeletal hyperostosis (cDISH) to matched control for each group, with and without fractures. The current multicenter study was a retrospective analysis of 140 patients aged 65years or older with cDISH-related cervical spine injuries; 106 fractures and 34 spinal cord injuries without fracture were identified. Propensity score-matched cohorts from 1363 patients without cDISH were generated and compared. Logistic regression analysis was performed to determine the risk of early mortality for patients with cDISH-related injury. Patients with cDISH-related injuries with fracture did not differ significantly in the incidence of each complication and ambulation or severity of paralysis compared to matched controls. In patients with cDISH-related injury without fracture, those who were nonambulatory at discharge comprised 55% vs 34% of controls, indicating significantly poorer ambulation in those with cDISH-related injuries (P = .023). There was no significant difference in the incidence of complications and ambulation or paralysis severity at 6months as compared with controls. Fourteen patients died within 3months. Logistic regression analysis identified complete paralysis (odds ratio [OR] 36.99) and age (OR 1.24) as significant risk factors for mortality. The current study showed no significant differences in the incidence of complications, ambulation outcomes between patients with cDISH-related injury with fracture and matched controls, and that the ambulation at discharge for patients with cDISH-related injury without fractures were significantly inferior to those of matched controls.

Acute Cervical Spine Trauma: Imaging Assessment and Management

The intent of this article is to provide a comprehensive, educational overview of cervical spinal trauma, bringing together the mechanism of injury, imaging assessment, common injury patterns and classification systems, and acute management. Accompanying illustrations will act as powerful tools for comprehension. These concepts will be underpinned by frequent reference to neuroradiology and a grounding of cervical spinal anatomy. Although primarily aimed at the reporting radiologist, this article will serve as an important scholastic adjunct to other clinical specialties, including emergency physicians, trauma and orthopedic surgeons, and neurosurgeons.Learning Objective: To understand cervical spinal anatomy, describe the common mechanisms and patterns of cervical spinal injury, and identify injuries for which further imaging assessment is recommended

Fracture Dislocation in the Cervical Spine – A Case Series Analysis of 32 Cases and Review of Literature

Abstract Complex cervical spine injuries result from road traffic accidents, fall from height, diving in the swimming pool, fall along with the ladder etc. This is a major cause of disability, morbidity and mortality and dependence. Most of these injuries are preventable by proper care, social reforms, teaching civic sense to students at an early age, adoption of safety measures while climbing heights, enforcement of traffic rules, building up of infrastructure, educating the people and mandatory emergency room service for the offenders. Fracture dislocations of the cervical spine mostly flexion distraction injuries. Dislocations can range from perched facets, unilateral facet dislocations to bilateral facet dislocations and spondyloptosis. These result in varying degrees of neurological deficit. The recovery of these patients depend on the initial magnitude of the injury, the safe transport of the victim to the trauma centre, careful management of the injuries and rehabilitation. Here a case series of 32 patients with varying degrees of fracture dislocations of the cervical spine are analyzed retrospectively.

Stress analysis of the screw of atlantoaxial posterior screw fixation C1LM-C2PS and C1LM-C2PARS with and without rod: A FEM based study

Human cervical spine consists of three vertebrae C0-occiput, C1-atlas, & C3-axial in its upper part. The atlantoaxial complex is the most portable segment of the cervical spine and is accountable for half of the flexion, extension, and axial rotation movements of the neck. Atlantoaxial cervical spine injuries are serious injuries since there is a likely risk of harm to the spinal cord. Sustaining stability of the atlantoaxial joint following a neck injury is a difficult task because both vertebrae have complicated anatomy. Thus, the strength of a bone screw is especially significant in the early post-operative stages. Different stabilization procedures have been accounted for C1-C2 injury fixation, out of which fixation with transarticular screws is considered as the gold standard procedure. But screw malposition and high riding transverse foramen of the C2 vertebra are some limitations of this fixation technique. Current FE-based study provides a comparison of the biomechanical stability of the two different atlantoaxial posterior screw fixation techniques (C1Lateral Mass-C2 Pedicle screws, C1Lateral Mass-C2PARS screws).In this work, a C1-C2 cervical spine model of a male patient is developed using MRI CT scan data using a 3-d slicer software and biomechanical stability comparison is done for C1LM-C2PS & C1LM-C2PARS screws fixed once with a supporting posterior screw fixation rod and once without rod under the physiological loading conditions of flexion, extension, lateral bending, and axial rotation using ANSYS WORKBENCH 16.2. The effects of the engaging supporting rod on the cervical spine were evaluated in the form of von-mises stresses induced in screws. Result shows reduction in screw stress values when implanted with supporting rods. C1LM-C2PS screw fixation with rod might be thought of as the best fixation solution for fractured C1-C2 vertebrae as it showed minimum stress values in the analysis as compared to C1LM-C2PARS with and without rod.

Neurogenic Shock: A Case Report

BackgroundNeurogenic shock is a life-threatening emergency associated with spinal cord injuries. Early cervical spine immobilization to reduce the risk of neurogenic shock is imperative. In addition, early recognition and treatment of neurogenic shock are essential to prevent hypoperfusion-related injuries and death. Case PresentationThis case outlines a 65-year-old male who experienced a cervical spine fracture after a motorcycle crash. The patient received stabilizing treatment by a flight crew consisting of both a registered nurse and paramedic. After assessment and stabilization, he was diagnosed as having neurogenic shock. Despite invasive treatment and resuscitation efforts, the patient succumbed to his injuries. ConclusionIt is important for emergency nurses to quickly identify the risk factors for cervical spine injuries and maintain cervical spine immobilization to minimize the risk of neurogenic shock.

On-Field and Pitch-Side (Sideline) Assessment of Sports Concussion in Collision Sports: An Expert Consensus Statement Using the Modified Delphi Technique

To perform a Delphi consensus for on-field and pitch-side assessment of sports-related concussion (SRC). Open-ended questions in rounds 1 and 2 were answered. The results of the first 2 rounds were used to develop a Likert-style questionnaire for round 3. If agreement at round 3 was ≤80% for an item, if panel members were outside consensus, or there were >30% neither agree/disagree responses, the results were carried forward into round 4. The level of agreement and consensus was defined as 90%. Loss of consciousness (LOC) or suspected LOC, motor incoordination/ataxia, balance disturbance, confusion/disorientation, memory disturbance/amnesia, blurred vision/light sensitivity, irritability, slurred speech, slow reaction time, lying motionless, dizziness, headaches/pressure in the head, falling to the ground with no protective action, slow to get up after a hit, dazed look, and posturing/seizures were clinical signs of SRC and indicate removal from play. Video assessment is helpful but should not replace clinical judgment. LOC/unresponsiveness, signs of cervical spine injury, suspicion of other fractures (skull/maxillo-facial), seizures, Glasgow Coma Scale score <14 and abnormal neurologic examination findings are indications for hospitalization. Return to play should only be considered when no clinical signs of SRC are present. Every suspected concussion should be referred to an experienced physician. Consensus was achieved for 85% of the clinical signs indicating concussion. On-field and pitch-side assessment should include the observation of the mechanism, a clinical examination, and cervical spine assessment. Of the 19 signs and red flags requiring removal from play, consensus was reached for 74%. Normal clinical examination and HIA with no signs of concussion allow return to play. Video assessment should be mandatory for professional games but should not replace clinical decision-making. Sports Concussion Assessment Tool, Glasgow Coma Scale, vestibular/ocular motor screening, Head Injury Assessment Criteria 1, and Maddocks questions are useful tools. Guidelines are helpful for non-health professionals. Level V, expert opinion.

Retracted: The Correlation between Functional Connectivity of the Primary Somatosensory Cortex and Cervical Spinal Cord Microstructural Injury in Patients with Cervical Spondylotic Myelopathy.

[This retracts the article DOI: 10.1155/2022/2623179.].

Effect of muscle activation scheme in human head-neck model on estimating cervical spine ligament strain from military volunteer frontal impact data

Cervical spine (c-spine) injuries are a common injury during automobile crashes. The objective of this study is to verify an existing head-neck (HN) finite element model with military volunteer frontal impact kinematics by varying the muscle activation scheme from previous literature. Proper muscle activation will allow for accurate percent elongation (strain) of the c-spine ligaments and will serve to establish ligamentous response during non-injury frontal impacts. Previous human research volunteer (HRV) frontal impact sled tests reported kinematic data that served as the input for HN model simulation. Peak sled acceleration (PSA) was varied between 10G and 30G for HRVs. Muscle activation was shifted to begin at 0 ms at start of impact to allow for proper muscle contraction in the HN model. Then, extensor muscle activation magnitude was varied between 20 and 100% to determine the proper activation necessary to match kinematic outputs from the model with experimental results. The model was validated against 10G test recorded response. Ligament strain was measured from multiple ligaments along the c-spine once the model was verified. The 40% activated extensor muscle scheme was deemed the most biofidelic, with CORA scores of 0.743 and 0.686 for head X linear acceleration and angular Y acceleration for 10G pulse. All PSA groups scored well with this muscle activation. Most ligaments were buffered well by the active simulation, with only the interspinous ligament nearing physiologic injury. With the HN model verified against additional kinematic data, simulations with higher accelerations to predict areas of injury in real life crash scenarios are possible.

Nasotracheal intubation awake in a patient with multiple fractures of the maxilla and cervical spine: A case report.

Nasotracheal intubation is an advanced airway modality used in specific contexts, such as limited mouth opening, macroglossia, cervical spine instability. In addition, it can be performed with the patient awake, especially when predictors a difficult airway are unknown. A 41-year-old male with a lesion in the C1 cervical vertebra, associated with a fracture of the right maxilla, was intubated through the nasopharyngeal route while awake. The forms of induction were discussed. Based on the mechanism of trauma and on the report of pain, associated with imaging examination, fracture of the body of the right maxilla and a complex fracture of the anterior arch of the C1 cervical vertebra were diagnosed. In this case, we present a patient with trauma to the face and spine who was intubated through the nasopharyngeal route while awake and guided by video laryngoscopy and using a rigid cervical collar. The patient was operated on under total general anesthesia (propofol and remifentanil) and plates and screws were placed for maxillary osteosynthesis. The pain was alleviated with a peripheral block of the trigeminal nerve of the maxillary branch with 0.5% levobupivacaine. The patient woke up from surgery, was extubated uneventfully and without pain. Cervical spine injuries were followed up by the neurosurgery team for conservative treatment. Patients with neck injury and facial trauma may need a definitive airway either for emergencies or for elective procedures. Intubating the awake patient may be an option when the anatomy of the cavity is unknown, and inducing the anesthetic act without this knowledge may be a inappropriate option, due to the risk of intubation/ventilation difficulties.