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

• Main Authors: Mark M. Zaki, Matthew J. Koch, Aman B. Patel, Ganesh M. Shankar
• Format: Article
• Language: English
• Published: Elsevier 2021-12-01
• Series: Interdisciplinary Neurosurgery
• Subjects: Concurrent; Carotid; Cervical; Stenosis; Endarterectomy
• Online Access: http://www.sciencedirect.com/science/article/pii/S2214751921002607

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.