Postoperative stroke after anterior cervical discectomy and fusion in patients with carotid artery stenosis: a statewide database analysis

Carotid artery injury and stroke secondary to prolonged retraction remains an extremely rare complication in anterior cervical discectomy and fusion (ACDF). However, multiple studies have demonstrated that carotid artery retraction during the surgical approach may alter the normal blood flow, leadin...

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Bibliographic Details
Published in:The spine journal 2019-04, Vol.19 (4), p.597-601
Main Authors: Chughtai, Morad, Sultan, Assem A., Padilla, Jorge, Beyer, George A., Newman, Jared M., Davidson, Iyooh U., Ilyas, Haariss, Udo-Inyang, Inyang, Berger, Ryan J., Samuel, Linsen T., Shankar, Ganesh M., Paulino, Carl B., Pelle, Dominic, Savage, Jason W., Steinmetz, Michael P., Mroz, Thomas E.
Format: Article
Language:English
Subjects:
ACDF
Adult
Aged
Anterior cervical discectomy and fusion
Carotid stenosis
Carotid Stenosis - complications
Carotid Stenosis - epidemiology
Cervical Vertebrae - surgery
Comorbidity
Complications
Databases, Factual
Diskectomy - adverse effects
Diskectomy - methods
Female
Humans
Incidence
Male
Middle Aged
Outcomes
Postoperative Complications - epidemiology
Spinal Fusion - adverse effects
Spinal Fusion - methods
Stroke
Stroke - epidemiology
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Summary:Carotid artery injury and stroke secondary to prolonged retraction remains an extremely rare complication in anterior cervical discectomy and fusion (ACDF). However, multiple studies have demonstrated that carotid artery retraction during the surgical approach may alter the normal blood flow, leading to a significant reduction in the cross-sectional area of the vessel. Others have suggested that dislodgment of atherosclerotic plaques following manipulation of the carotid artery can be a potential risk for intracranial embolus and stroke. We aimed to evaluate: (1) the incidence of postoperative stroke following ACDF and (2) incidence of other postoperative complications in a cohort of patients who had a diagnosis of carotid artery stenosis (CAS) versus those who did not. This study utilized the Statewide Planning and Research Cooperative System database from January 1, 2009 to December 31, 2013. All patients who underwent (ACDF) and had a preoperative diagnosis of CAS were identified using the International Classification of Disease, ninth revision codes. Those who had a previous history of stroke were excluded. Patients who had CAS were propensity score matched to patients without history of CAS for demographics and Charlson/Deyo comorbidity scores. Incidence of postoperative stroke and other complications were compared between the cohorts. The threshold for statistical significance was set at a p
ISSN:1529-9430
1878-1632
DOI:10.1016/j.spinee.2018.09.011