case_images: PMC11828767_01
case_images: Degree of spinal deformity. Preoperative CT images (sagittal and coronal section). Postoperative posterior spinal fusion from the 9th thoracic vertebra to the 1st sacral vertebra. The 2nd lumbar vertebra (red arrow) and the 5th lumbar vertebra (blue arrow) are highly crushed, and the 4th lumbar vertebra and the 1st sacral vertebra form a false joint (yellow circle)
case_images: 40981_2025_773_Fig1_HTML.jpg
case_images: PMC11828767_01_40981_2025_773_Fig1_HTML.jpg
case_images: Fig1
case_images: Since then, progressive camptocormia, spinal deformity (Fig. 1), and paravertebral muscle weaking from multiple spinal surgeries led to a long-seated forward flexion in bed and a sacral pressure ulcer.
case_images: Severe long-seated forward flexion position. The patient's face is buried between his knees
case_images: 40981_2025_773_Fig2_HTML.jpg
case_images: PMC11828767_01_40981_2025_773_Fig2_HTML.jpg
case_images: Fig2
case_images: In the long-seated forward flexion position, he managed to eat with back support from towels; however, without support, his face was buried between his knees (Fig. 2).
case_images: Space for airway management and positioning methods in the right lateral position. Sufficient space for airway management is observed in the patient while extending the lumbar region to the extent of no pain in the right lateral position. The patient's legs were held by a limb band (blue arrow), and a pillow (red arrow) was placed between the legs to prevent nerve damage and pressure ulcers. The legs were not supported or pulled up by the staff to provide space
case_images: 40981_2025_773_Fig3_HTML.jpg
case_images: PMC11828767_01_40981_2025_773_Fig3_HTML.jpg
case_images: Fig3
case_images: Legs were secured with limb bands, unsupported by staff, with pillows placed in between to prevent nerve damage and pressure ulcers (Fig. 3).
case_images: Intubation. Endotracheal intubation was achieved easily using the McGRATH  MAC video laryngoscope, with a Cormack classification of I. The hand on the patient's leg is the hand of the intubation assistant, and no force was applied to support or pull up the legs
case_images: 40981_2025_773_Fig4_HTML.jpg
case_images: PMC11828767_01_40981_2025_773_Fig4_HTML.jpg
case_images: Fig4
case_images: In the right lateral position, mask ventilation was easy, and endotracheal intubation with an 8.5-mm internal diameter reinforced tube (Covidien Japan, Tokyo, Japan) was successfully achieved on the first attempt using the McGRATH  MAC video laryngoscope (Medtronic, Minneapolis, MN, USA), with a Cormack classification of I (Fig. 4).