Protecting Your Neck During Anesthesia: Essential Precautions for People with Ehlers-Danlos Syndrome

If you have Ehlers-Danlos Syndrome (EDS), even routine procedures like dental work, oral and nasal surgeries, or even just anesthesia for other care can carry unique risks. One of the most serious is craniocervical instability (CCI), which can be worsened or even triggered by neck hyperextension during procedures like intubation or hyperextended reclined positioning.

Why Neck Hyperextension Is Dangerous

For individuals with EDS, the connective tissue that stabilizes the joints, including those in the upper spine, is often too lax. This means even small shifts in neck positioning, especially hyperextension, can strain vulnerable ligaments, compress the brainstem, or injure the spinal cord (Rao et al., 2005; Chopra & Bluestein, 2020). These risks may be present even in patients who have not yet been diagnosed with CCI, especially during surgeries involving the mouth or nose.

Studies show that patients with EDS may develop CCI or related issues after intubation or anesthesia due to mechanical stress on the craniocervical junction (Lohkamp et al., 2022). This is especially concerning given that EDS is often undiagnosed, meaning many individuals may not even be aware of the risk until complications arise.

Dental and Surgical Procedures: A High-Risk Zone

Whether you’re reclining for a dental filling or undergoing oral/nasal surgery under general anesthesia, neck positioning matters. The combination of neck extension and jaw manipulation can destabilize an already vulnerable area. Additionally, EDS is associated with temporomandibular joint (TMJ) dysfunction, Chiari malformation, tracheomalacia, and other anatomic abnormalities that may complicate airway management (Chopra & Bluestein, 2020; Kui et al., 2024).

What You Can Do to Protect Yourself

• Wear a rigid cervical collar (like an Aspen Vista or Miami J) during any procedure requiring neck manipulation, intubation, or prolonged positioning.
• Inform your dental or surgical team in advance about your EDS diagnosis or hypermobility symptoms.
• Request neutral positioning of your head and neck throughout the procedure.
• Advocate for fiberoptic intubation if undergoing general anesthesia, as it minimizes cervical manipulation and TMJ strain (Chopra & Bluestein, 2020).

Not Just the Dentist: Take These Precautions for Any Anesthesia

Although much attention is paid to dental positioning, these precautions apply broadly. People with EDS should take similar measures during any anesthesia: including endoscopic procedures, nasal surgeries, or even imaging requiring sedation. The risk isn’t limited to diagnosed CCI; EDS patients are at risk of developing CCI from poorly supported positioning or excessive cervical manipulation.

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Chopra, P., & Bluestein, L. (2020). Perioperative care in patients with Ehlers-Danlos Syndromes. Open Journal of Anesthesiology, 10(1), 13–29. https://doi.org/10.4236/ojanes.2020.101002

Kui, A., Bereanu, A., Condor, A. M., Pop, D., Buduru, S., Labunet, A., … & Chisnoiu, A. (2024). Craniocervical posture and malocclusion: A comprehensive literature review of interdisciplinary insights and implications. Medicina, 60(12), 2106.

Lohkamp, L. N., Marathe, N., & Fehlings, M. G. (2022). Craniocervical instability in Ehlers-Danlos syndrome—a systematic review of diagnostic and surgical treatment criteria. Global Spine Journal, 12(8), 1862–1871.

Rao, S. K., Wasyliw, C., & Nunez Jr, D. B. (2005). Spectrum of imaging findings in hyperextension injuries of the neck. Radiographics, 25(5), 1239–1254.

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