Background The Airtraq laryngoscope (Prodol Ltd., Vizcaya, Spain) is a novel single-use tracheal intubation device. The authors compared ease of intubation with the Airtraq and Macintosh laryngoscopes in patients with cervical spine immobilization in a randomized, controlled clinical trial.Methods: Forty consenting patients presenting for surgery requiring tracheal intubation were randomly assigned to undergo intubation using a Macintosh (n = 20) or Airtraq (n = 20) laryngoscope. All patients were intubated by one of four anesthesiologists experienced in the use of both laryngoscopes.Results: No significant differences in demographic or airway variables were observed between the groups. All but one patient, in the Macintosh group, were successfully intubated on the first attempt. The Airtraq reduced the duration of intubation attempts (mean +/- SD: 13.2 +/- 5.5 vs. 20.3 +/- 12.2 s), the need for additional maneuvers, and the intubation difficulty scale score (0.1 +/- 0.5 vs. 2.7 +/- 2.5). Tracheal intubation with the Airtraq caused fewer alterations in blood pressure and heart rate.Conclusions: These findings demonstrate the utility of the Air-traq laryngoscope for tracheal intubation in patients with cervical spine immobilization.