Objective To compare the clinical efficacy of the video intubationscope and Macintosh direct laryngoscope in simulated cervical spine immobilization. Methods Sixty patients, ASA Ⅰ or Ⅱ, between 19 and 68 years old, underwent general anesthesia requiring oro-tracheal intubation, were randomly assigned to undergo intubation using video intubationscope (group V) or Macintosh direct laryngoscope (group M), 30 cases in each. Each patient was provided mannal in-line axial stabilization of the head and neck by an experienced assistant. The following data were recorded and analyzed: glottic exposure time, Cormark-Lehane grade (C-L classification), tracheal intubation time, total intubation attempts, manoeuvre needed to aid tracheal intubation, failure for tracheal intubation, one-time success rate of tracheal intubation and total success rate of tracheal intubation, mean arterial pressure (MAP) and heart rate (HR) before induction of anesthesia, before intubation, at glottic exposure, at intubation, 1 and 3 min after intubation, and complications. Results Compared with group M, better glottic exposure view (C-L classification) was achieved in group V (P < 0.05), and the tracheal intubation time was shorter (P < 0.05), but the glottic exposure time was longer (P < 0.05). More assistance was need and the intubation failure and complication rate was higher in group M (P < 0.05). Compared with T1, MAP in group M were significantly increased at T2~T5 (P < 0.05), MAP in group V were no significantly changed at T2 (P > 0.05) and were significantly increased at T3~T5 (P < 0.05); compared with group M, MAP at T2~T4 in group V were significantly lower (P < 0.05). Compared with T1, HR in group V were no significantly changed at T2~T5, HR in group M were significantly increased at T2~T4 (P < 0.05), and significantly higher than that in group V at the same time point (P < 0.05). Conclusion Compared with Macintosh direct laryngoscopy in patients with cervical spine immobilization, Video intubationscope could provide better view of glottic exposure, decrease the difficulty of intubation and increase the success rate of intubation, have less complications and influence on patient’s hemodynamics.