Retrograde Intubation in a Severe Fixed Spinal Deformity: A Case Report

Retrograde intubation is a seldom used but valuable technique in managing difficult airways, especially in resource-limited settings when advanced equipment is unavailable or ineffective.

We report the case of a 64-year-old male with advanced ankylosing spondylitis and severe cervicothoracolumbar kyphosis who presented with altered mental status and respiratory distress. Extreme fixed cervical flexion, markedly restricted mouth opening, and an inaccessible anterior neck rendered direct laryngoscopy, video laryngoscopy, fiberoptic intubation, and surgical airway approaches unfeasible. Retrograde nasotracheal intubation was successfully performed, resulting in airway stabilization and hemodynamic improvement.

This case highlights retrograde intubation as a lifesaving low-technology technique in complex anatomic and physiologic airways, demonstrating its continued relevance under the updated Difficult Airway Society 2025 guidelines.