title: Brown-Sequard-type myelopathy due to cervical disc herniation associated with severe carotid stenosis prompting rapid combined corpectomy and carotid endarterectomy under deep anticoagulant therapy.
abstract: BACKGROUND
  The risk of stroke because of carotid retraction during an anterior cervical spine surgery as well as the risk of bleeding complications after an anterior cervical corpectomy under deep anticoagulation and antiplatelet therapy is a surgical issue poorly addressed in the literature.
  
  
  OBJECTIVE
  To describe the feasibility and safety of a simultaneous carotid endarterectomy and anterior corpectomy and fusion under deep anticoagulation in a patient with a cervical spinal cord compression and a severe carotid artery stenosis.
  
  
  METHODS
  Case report.
  
  
  METHODS
  The authors describe the case of a 79-year-old man who had a 1-month history of progressive pain in the neck and left arm, associated with progressive weakness in the left arm and leg. He also presented a history of coronaropathy and bilateral severe carotid stenosis for which he was receiving a regimen of antiplatelet therapy.
  
  
  RESULTS
  The cervical magnetic resonance imaging demonstrated a C4-C5 disc herniation migrating down to C5. His condition worsened rapidly during hospitalization prompting a rapid decompression. Given the necessity of a C5 corpectomy and the risk of stroke during anterior cervical spine surgery, it was therefore decided to undertake the surgical procedure under efficient anticoagulant and antiplatelet therapy. A combined endarterectomy and spinal decompression and fusion were then performed. The postoperative course was uneventful, and the patient recovered neurologically.
  
  
  CONCLUSIONS
  This case suggests that such a combined carotid endarterectomy and cervical corpectomy with fusion under anticoagulant and antiplatelet therapy is feasible. However, even if the unique clinical presentation of our patient led us to undertake such a surgical strategy, therapeutic decision in patients presenting with both severe carotid stenosis and cervical spinal cord compression should rely on a case-by-case analysis.
authors.affiliation: Department of Neurosurgery, Timone University Hospital, 264 rue Saint-Pierre, 13005 Marseille, France.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Laghmari
authors.forename: Benjamin
authors.initials: B
authors.lastname: Blondel
authors.forename: Philippe
authors.initials: P
authors.lastname: Metellus
authors.forename: Michel
authors.initials: M
authors.lastname: Bartoli
authors.forename: Stephane
authors.initials: S
authors.lastname: Fuentes
authors.forename: Gregoire
authors.initials: G
authors.lastname: Pech-Gourg
authors.forename: Tarek
authors.initials: T
authors.lastname: Adetchessi
authors.forename: Henry
authors.initials: H
authors.lastname: Dufour
authors.forename: Alain
authors.initials: A
authors.lastname: Branchereau
authors.forename: Francois
authors.initials: F
authors.lastname: Grisoli
mesh_terms: D000368:Aged; D000792:Angiography; D000925:Anticoagulants / Q000627:therapeutic use*; D018437:Brown-Sequard Syndrome / Q000150:complications / Q000209:etiology / Q000601:surgery*; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D002574:Cervical Vertebrae; D016894:Endarterectomy, Carotid / Q000379:methods*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery*; D008297:Male; D013117:Spinal Cord Compression / Q000601:surgery; D013118:Spinal Cord Diseases / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods*; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants