Unstable cervical spine; is it still a contraindication for percutaneous tracheostomy as thought before?

We report a 28 year old male with an unstable acute traumatic cervical spinal cord injury (SCI) due to anterior spondylolisthesis of C6 over C7 vertebra and facet joint dislocation of C6-C7 who underwent a successful bronchoscopy guided percutaneous tracheostomy (PCT) on day 6. Cervical SCI demands tracheostomy in majority but SCI with unstable cervical spine itself makes tracheostomy a challenging procedure. Even though cervical SCI was considered a relative contraindication for PCT, it can be safely performed in neutral neck position. Addition of ultrasound scanning of neck and bronchoscopic guidance further increases its safety profile. In cervical SCI early tracheostomy may be more effective than late.