Positional asphyxia associated with cervical vertebral fractures

Positional asphyxia refers to asphyxia resulting from an abnormal body posture that obstructs pulmonary ventilation. We report two cases in which individuals were unable to escape from positions that interfered with respiration, and cervical fractures were found upon autopsy. In the first case, a female in her 70s was found dead in a prone position on a bed following a traffic accident. Forensic autopsy findings suggested that she died from respiratory failure due to shallow breathing associated with pain from a rib fracture and prolonged prone positioning, possibly influenced by potential spinal cord injury associated with a cervical vertebral fracture. In the second case, a female in her 80s was found dead with her abdomen on a bed rail and her face down on the bed, a posture known as the jackknife position. Security camera footage showed that she was unable to escape from the position after the accidental fall, and after struggling in the same position for approximately 6 h, she became immobile, suggesting death by positional asphyxiation. Forensic autopsy revealed a fracture of the fifth cervical vertebra, raising the possibility of cervical spinal injury at the time of her fall. These cases indicate that cervical spinal fractures can be detected and associated with positional asphyxia deaths; however, their exact role in causing death remains uncertain. These findings highlight the importance of vigilant monitoring and timely medical intervention, particularly in older individuals, even when initial injuries appear minor.