Cricotracheostomy in a Patient With Severe Spinal Cord Injury: Its Usefulness in Trauma Patients Requiring Critical...

Patients with severe spinal cord injury (SCI) generally require prolonged mechanical ventilation, and early tracheotomy offers significant benefits. However, spinal immobilization is necessary, and the neck should not be extended in the acute phase, making appropriate positioning for tracheostomy challenging. Cricotracheostomy is a novel method involving a higher tracheal incision than the conventional approach and is often performed by otolaryngologists in patients with anatomical abnormalities. However, its utility in trauma patients requiring critical care remains unestablished. A male patient in his 60s was admitted to the ED with immobilization and breathing difficulties after falling from a standing position. CT revealed no radiological abnormalities of the cervical vertebrae, while MRI showed high signals in the third and fourth cervical vertebrae (C3-4). The patient was diagnosed with SCI without radiographic abnormalities. Owing to weakened respiration, he was placed on a ventilator. Because he did not undergo surgical cervical stabilization, a cervical collar was maintained. On the third post-trauma day (PTD), a cricotracheostomy was performed to avoid interference with the cervical collar and maintain airway safety, despite the absence of anatomical anomalies. On the 36th PTD, the patient was completely weaned from the ventilator, and vocalization was possible using a speech bulb. This case highlights the potential utility of cricotracheostomy in patients with severe SCI.