High-flow nasal oxygen with flexible channel oxygen insufflation for ankylosing spondylitis and cervical fracture-dislocation: a case report and literature review

BACKGROUND: Ankylosing spondylitis predisposes patients to cervical fracture and spinal cord injury after minor trauma. Tracheal intubation must therefore be performed with minimal cervical motion to avoid iatrogenic neurological damage, a challenge for the anaesthetist. CASE PRESENTATION: A 41-year-old man with ankylosing spondylitis sustained a traumatic fracture of the seventh cervical spine, with displacement and spinal cord compression. After thorough airway assessment, he received high-flow nasal oxygen to maintain oxygenation, combined with oxygen insufflation through the flexible working channel. Following induction of general anaesthesia and muscle relaxation, a fibrescope was advanced into the trachea without cervical spine movement, and intubation was successfully completed. CONCLUSION: In the present case, combining high-flow nasal oxygen with oxygen insufflation through the flexible working channel permits flexible intubation while avoiding cervical motion and securing the airway safely.