title: Motion generated in the unstable upper cervical spine during head tilt-chin lift and jaw thrust maneuvers.
abstract: BACKGROUND
  Although it is essential to maintain a secure airway in a trauma patient, it is also critical to protect the potentially injured cervical spine. It has previously been suggested that the jaw thrust maneuver be used in place of the head tilt-chin lift in the suspected spine-injured patient.
  
  
  OBJECTIVE
  We sought to examine whether the jaw thrust was in fact safer to use in the setting of an unstable upper cervical spine injury.
  
  
  METHODS
  Unstable, dissociative C1-C2 injuries were surgically created in nine fresh, lightly embalmed human cadaver specimens. An electromagnetic motion analysis device was used to assess the amount of angular and linear motion with sensors placed above and below the injured segment. Measurements were recorded during execution of the two airway maneuvers. Trials were performed both with and without a cervical immobilization collar in place.
  
  
  RESULTS
  There was almost twice as much angular motion in all planes when performing a head tilt-chin lift as compared with the jaw thrust, and this was statistically significant (p<.013). In addition, there was more displacement at the injured level with a head tilt-chin lift as compared with the jaw thrust. This was statistically significant for axial displacement and anteroposterior translation (p=.003 for both), and approached significance for mediolateral translation (p=.056).
  
  
  CONCLUSIONS
  The jaw thrust maneuver results in less motion at an unstable C1-C2 injury as compared with the head tilt-chin lift maneuver. We therefore recommend the use of the jaw thrust to improve airway patency in the trauma patient with suspected cervical spine injury.
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Texas, 6400 Fanon Suite 1700, Houston, TX 77030, USA. Electronic address: mark.l.prasarn@uth.tmc.edu.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Prasarn
authors.affiliation: Department of Orthopaedics & Rehabilitation, University of Florida, PO Box 112727, Gainesville, FL 32611, USA.
authors.forename: Marybeth
authors.initials: M
authors.lastname: Horodyski
authors.affiliation: Florida Cancer Specialist and Research Institute, 8931 Colonial Center Drive, Fort Myers, FL 33905, USA.
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Scott
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Texas, 6400 Fanon Suite 1700, Houston, TX 77030, USA.
authors.forename: Geoff
authors.initials: G
authors.lastname: Konopka
authors.affiliation: Department of Orthopaedics & Rehabilitation, University of Florida, PO Box 112727, Gainesville, FL 32611, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Conrad
authors.affiliation: Department of Orthopaedics, Veterans Affairs Hospital, 10000 Bay Pines Blvd N, St. Petersburg, FL 33708, USA.
authors.forename: Glenn R
authors.initials: GR
authors.lastname: Rechtine
mesh_terms: D058109:Airway Management / Q000009:adverse effects / Q000379:methods*; D002102:Cadaver; D002574:Cervical Vertebrae / Q000502:physiology*; D002680:Chin; D006257:Head / Q000502:physiology*; D006801:Humans; D007103:Immobilization / Q000009:adverse effects / Q000379:methods*; D007568:Jaw / Q000502:physiology*; D007593:Joint Instability; D009038:Motion; D016059:Range of Motion, Articular / Q000502:physiology*; D013124:Spinal Injuries / Q000628:therapy*; D013131:Spine
keywords: Airway; Cervical spine; Fracture; Maneuvers; Unstable