Perioperative stroke following anterior cervical discectomy

Radhakrishnan, M.; Bansal, Sonia; Srihari, G.; Somanna, Sampath; Gs, Rao

doi:10.3109/02688691003711575

Cited by 14 publications

(18 citation statements)

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“…This is the first case of such a complication occurring beyond the immediate perioperative period, and only the fifth reported cerebral infarct attributable to any etiology after ACDF without corpectomy. [ 1 2 9 11 ]…”

Section: Discussionmentioning

confidence: 99%

“…Subsequent investigations revealed a wide range of underlying stroke etiologies, including prolonged retraction compressing the carotid artery, a congenitally abnormal Circle of Willis, and hypotension in the setting of atherosclerosis. [ 1 2 9 11 ] We report the case of a 61-year-old man with a history of pulmonary embolism (PE) and atrial fibrillation, who developed delayed stroke 3 days following an ACDF, most likely attributable to severe but asymptomatic and undiagnosed carotid atherosclerosis, vessel manipulation, coagulopathy, and acute dehydration, which collectively precipitated a large watershed infarct.…”

Section: Introductionmentioning

confidence: 99%

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Delayed cerebral infarct following anterior cervical diskectomy and fusion

et al. 2016

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Background:Ischemic stroke following anterior cervical diskectomy and fusion (ACDF) is an exceedingly rare complication. There are only three previous cases focusing on this problem in the literature; here, we present the fourth case.Case Description:A patient, cared for at an outside institution, developed a delayed ischemic stroke 3 days following an ACDF. This complication was attributed to carotid manipulation precipitating vascular injury in the setting of multiple comorbid vascular and coagulopathic risk factors, including previously undiagnosed carotid atherosclerosis, a prior history of pulmonary embolus requiring Warfarin anticoagulation (held perioperatively), acute dehydration, and atrial fibrillation.Conclusions:This case demonstrates the importance of focused history and examination in appropriate patients prior to ACDF, with special consideration given to the significance of age, comorbidities including coagulopathy and arrhythmia, and potential underlying vascular disease as markers for increased risk of perioperative thrombotic stroke associated with carotid manipulation. Patients at higher risk warrant comprehensive preoperative assessment, including medical evaluation, carotid imaging, and consideration for alternative surgical approaches.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Delayed cerebral infarct following anterior cervical diskectomy and fusion

et al. 2016

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“…Furthermore, during cervical corpectomy or cervical discectomy, prolonged carotid artery retraction has been associated with CVA in a few cases. 3,4,9 Yeh et al 4 reported a case in which an extensive right hemispheric infract occurred 72 hours after anterior cervical corpectomy of C4.…”

Section: Discussionmentioning

confidence: 99%

“…Last, Radhakrishnan et al 9 presented a case of postoperative stroke following anterior cervical discectomy that involved carotid artery manipulation. However, the CVA complication was attributed to intraoperative hypotension, which was believed to be caused by a continuation of antihypertensive medication rather than carotid retraction.…”

Section: Discussionmentioning

confidence: 99%

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Carotid Artery Injury in Anterior Cervical Spine Surgery: Multicenter Cohort Study and Literature Review

Härtl¹,

Alimi

Boukebir

et al. 2017

Global Spine Journal

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Study Design:Retrospective study and literature review.Objective:To provide more comprehensive data about carotid artery injury (CAI) or cerebrovascular accident (CVA) related to anterior cervical spine surgery.Methods:We conducted a retrospective, multicenter, case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records of 17 625 patients who went through cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were analyzed. Also, we performed a literature review using Medline and PubMed databases. The following terms were used alone, and in combination, to search for relevant articles: cervical, spine, surgery, complication, iatrogenic, carotid artery, injury, cerebrovascular accident, CVA, and carotid stenosis.Results:Among 17 625 patients that were analyzed, no cases were reported to experienced CAI or CVA after cervical spine surgery. Nevertheless, in our PubMed search we found 157 articles, but only 5 articles matched our study objective criteria; 2 cases were reported to present CAI and 3 cases presented CVA.Conclusions:CAI and CVA related to anterior cervical spine surgeries are extremely rare. We were not able to find neither in our retrospective study nor in our literature research a correlation between the type or length of anterior cervical spine procedure with CVA or CAI complications. However, surgeons should be aware of the possibility of vascular complications and minimize intraoperative direct vascular manipulations or retraction. Preoperative screening for underlying vascular pathology and risk factors is also important.

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Remote Complications Overview

2017

Imaging in Spine Surgery

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Perioperative stroke following anterior cervical discectomy

Abstract: We describe a case of postoperative stroke in a patient undergoing anterior cervical discectomy caused by a combination of intraoperative retraction of an atherosclerotic carotid vessel and arterial hypotension.

Cited by 14 publications

References 5 publications

Delayed cerebral infarct following anterior cervical diskectomy and fusion

Delayed cerebral infarct following anterior cervical diskectomy and fusion

Carotid Artery Injury in Anterior Cervical Spine Surgery: Multicenter Cohort Study and Literature Review

Remote Complications Overview

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