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Postoperative stroke after anterior cervical discectomy and fusion in patients with carotid artery stenosis: a statewide database analysis
- Source :
- The spine journal : official journal of the North American Spine Society. 19(4)
- Publication Year :
- 2018
-
Abstract
- 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.05. This study received no funding. The authors report no conflict of interests relevant to this study.There were 34,975 patients who underwent an ACDF in the study time period. After excluding those under the age of 18 and with history of previous stroke, there were 61 patients who had CAS that were compared with a propensity-matched cohort. The CAS cohort had a significantly higher incidence of postoperative stroke during their hospitalization (6.6% vs 0%, p.042). The CAS cohort also had higher rates of acute renal failure (27.9% vs 4.9%, p = .01) and sepsis (18% vs 4.9%, p = .023). There were no stroke related deaths.Patients with CAS who underwent ACDF had a statistically significant greater incidence of developing a postoperative stroke. To the best of our knowledge, no previous study has evaluated the development of postoperative stroke in patients with CAS undergoing ACDF. Larger, multicenter studies are needed to estimate the true incidence of stroke in this specific patient population. However, our results may illustrate the importance of preoperative optimization, approach-selection, and postoperative stroke surveillance in patients with a history of CAS who undergoes ACDF.
- Subjects :
- Adult
Male
medicine.medical_specialty
Databases, Factual
Anterior cervical discectomy and fusion
Comorbidity
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Embolus
Medicine
Humans
Orthopedics and Sports Medicine
Carotid Stenosis
030212 general & internal medicine
Stroke
Aged
business.industry
Incidence (epidemiology)
Incidence
Middle Aged
medicine.disease
Surgery
Stenosis
Spinal Fusion
Cohort
Cervical Vertebrae
Female
Neurology (clinical)
business
Complication
030217 neurology & neurosurgery
Diskectomy
Subjects
Details
- ISSN :
- 18781632
- Volume :
- 19
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- The spine journal : official journal of the North American Spine Society
- Accession number :
- edsair.doi.dedup.....310b9f9f21141569006b748663153808