# Impact of Cervical Spine Immobility on Carotid Endarterectomy: A Report of Two Cases

## TL;DR

This paper reports two cases where limited neck movement due to spinal conditions made carotid artery surgery more difficult, highlighting the need for preoperative assessment of neck mobility.

## Contribution

The paper highlights cervical spine immobility as an underrecognized challenge in carotid endarterectomy.

## Key findings

- Severe cervical immobility from DISH and OPLL limited distal ICA exposure during CEA in two patients.
- Standard surgical techniques were insufficient to overcome the anatomical constraints in both cases.
- Preoperative assessment of range of motion is emphasized for high cervical lesions to guide treatment planning.

## Abstract

Carotid endarterectomy (CEA) is a well-established revascularization procedure for carotid artery stenosis. While anatomical challenges such as high carotid bifurcation and vascular anomalies are widely recognized, cervical spine immobility due to spinal pathology is infrequently considered during preoperative planning. This report presents two cases in which severe cervical immobility, resulting from diffuse idiopathic skeletal hyperostosis (DISH) and ossification of the posterior longitudinal ligament (OPLL), significantly limited distal exposure of the internal carotid artery (ICA) during CEA. The first case involved a 76-year-old man with symptomatic right ICA stenosis and plaque extending to the C3 level. The second case involved a 75-year-old man with asymptomatic severe left ICA stenosis reaching the C2 level. In both cases, imaging demonstrated extensive DISH and OPLL, and cervical immobility impeded distal ICA exposure despite standard techniques. These cases highlight cervical immobility as an underrecognized factor contributing to technical complexity in CEA and emphasize the importance of assessing the range of motion (ROM) limitations during preoperative evaluation for high cervical lesions. Early identification of such limitations may inform perioperative planning and support individualized treatment selection, including consideration of endovascular alternatives when appropriate.