A case report of simultaneous surgery for concurrent symptomatic carotid artery and cervical spinal stenosis

Symptomatic cervical spinal stenosis and carotid artery stenosis are common neurosurgical diseases, but little is known about the management of their concurrent presentation. We present a 62 year-old woman with a precipitous decline in bilateral lower extremity strength, dexterity, and gait, and a 2-year history of amaurosis fugax. She was found to have cervical stenosis at C5-C7 with cord compression, lumbar stenosis at L3-L5 with a right L4-L5 synovial cyst, and moderate right internal carotid artery stenosis of 50–70%. The patient underwent a staged procedure. Stage 1 was a simultaneous right carotid endarterectomy and C6 corpectomy with C5-C7 anterior fusion. Stage 2 was a C3-T1 posterior decompression and fusion and L3-L5 decompression with synovial cyst removal. The presentation of concurrent cervical stenosis and CAS is likely underappreciated. Deciding between simultaneous or staged CEA and spinal decompression should be based on a careful risk-benefit assessment and tailored to the relative severity of symptoms, patient anatomy and comorbidities.