A 50-year-old man with long-standing RA develops cervical myelopathy. MRI shows atlantoaxial subluxation with anterior atlantodental interval of 6 mm. What is the most important reason to assess this before any elective surgery under general anesthesia?
- A Risk of spinal cord compression during neck extension for laryngoscopy ✓
- B Risk of carotid artery injury during intubation
- C Cervical instability increases risk of pneumothorax during intubation
- D Atlantoaxial subluxation causes difficult mask ventilation due to tongue swelling
Correct answer: A. Risk of spinal cord compression during neck extension for laryngoscopy
Explanation
Atlantoaxial subluxation in RA results from erosion of the transverse ligament, allowing the odontoid to sublux posteriorly and compress the cervical spinal cord. During laryngoscopy, neck extension (required for conventional direct laryngoscopy) can worsen subluxation and cause acute cervical cord compression, quadriplegia, or death. Anesthesiologists must use awake fibreoptic intubation or videolaryngoscopy in neutral/minimal extension position. This is a well-recognized perioperative hazard in RA patients.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.