# Postoperative Stroke Following Anterior Cervical Spine Surgery: A Case Report

## TL;DR

A patient developed a stroke after cervical spine surgery, highlighting the need for pre-surgery vascular screening to prevent such complications.

## Contribution

The case emphasizes the importance of preoperative carotid and vertebral artery screening to identify risk factors for stroke.

## Key findings

- A patient developed stroke symptoms after anterior cervical spine surgery, including hemiplegia and drowsiness.
- Angio-CT revealed an atheromatous plaque in the internal carotid artery, likely contributing to the stroke.
- The patient had no significant medical history but was found to have dyslipidemia, a risk factor for vascular events.

## Abstract

Vascular complications succeeding anterior cervical spine surgery are rare, but their consequences represent a major burden for the patient. Cerebral infarction following anterior cervical discectomy and fusion (ACDF) is uncommon. However, screening for risk factors before surgery should become mandatory. We present the case of a patient with no significant medical history who underwent ACDF for a C5/C6 herniated disc with myelopathy. Although the surgery was uneventful, after the surgery, partial right palpebral ptosis and miosis were noted, suggestive of Horner syndrome. On the fifth postoperative day, the patient experienced left hemiplegia and drowsiness. An emergency CT scan and cerebral MRI revealed ischemia in the right middle cerebral artery territory. The patient was transferred to a neurology center for mechanical thrombectomy, which revealed a complete occlusion of the right internal carotid artery. The procedure had to be halted due to blood extravasation at the internal carotid artery bifurcation to prevent further complications. An angio-CT examination of the cervical arteries exposed a soft atheromatous plaque on the right internal carotid artery, immediately after the bifurcation. Despite the patient having no significant medical history, blood tests indicated dyslipidemia. At the two-month follow-up, the patient remained hemiplegic, with mild dysphasia. Performing carotid and vertebral Doppler ultrasound before cervical spine surgery might be useful, whenever possible, to assess high-risk factors for ischemic events and avoid such debilitating complications.