Cervical spine disease and anaesthesia

Surgery on the cervical spine is commonly performed to relieve compression of the spinal cord (myelopathy), a nerve root (radiculopathy) or to provide bony stabilization to prevent secondary neurological injury. The pathological causes of myelopathy and radiculopathy are a common consequence of osteoarthritis or less commonly due to tumours, trauma, disc herniation, infection and multisystem disease, and in some conditions as a result of their associated pathologically or surgically induced instability. Successful anaesthetic management should involve a meticulous preoperative assessment of the patient’s airway, a systemic review especially in patients with comorbidities and multisystem disease, and attention to their medication and analgesic requirements. Preoperative discussion with the surgical team allows planning of airway management, patient positioning, cardiovascular support (in cases with the potential for significant blood loss), the availability of appropriate blood products and monitoring, postoperative pain management and ward destination.