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.
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.
Laghmari
Mehdi
M
Department of Neurosurgery, Timone University Hospital, 264 rue Saint-Pierre, 13005 Marseille, France.
Blondel
Benjamin
B
Metellus
Philippe
P
Bartoli
Michel
M
Fuentes
Stephane
S
Pech-Gourg
Gregoire
G
Adetchessi
Tarek
T
Dufour
Henry
H
Branchereau
Alain
A
Grisoli
Francois
F
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
D000925:Anticoagulants