ArticleNorth American Spine Society journal2026
Postoperative complications after anterior cervical discectomy and fusion in patients with versus without carotid artery stenosis.
Article in North American Spine Society journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Carotid artery stenosis (CS) may elevate risk of stroke related to anterior cervical discectomy and fusion (ACDF) due to manipulation of the carotid artery and alteration in flow dynamics. Prior studies assessing this potential association are limited by small sample size and assessment of in-hospital stroke only. Methods: A retrospective cohort study was conducted to compare 90-day adverse events following ACDF in patients with versus without CS. Adult patients (age >17 years) without a history of stroke who underwent isolated 1-3 level ACDF were identified in the 2010-2023 PearlDiver M170 database. Patients with CS were matched 1:4 to patients without CS based on age, sex, and Elixhauser comorbidity index (ECI). Adverse outcomes, emergency department (ED) visits, and readmissions in the 90 postoperative days were identified and compared between groups with univariable and multivariable analyses, the latter controlling for age, sex, and ECI. The timing of stroke following surgery was also plotted on a Kaplan-Meier survival curve and compared by log-rank test. A secondary analysis was conducted comparing CS patients with and without a history of revascularization procedure. Results: Among patients in the database undergoing ACDF, 17,772 with and 423,401 without CS were identified. Following matching, final cohorts consisted of 16,888 CS patients and 67,355 matched controls. CS was associated with greater odds of cardiac events (OR=1.74, p<.001) and stroke (OR=1.49, p<.001), but not other assessed adverse outcomes. The incidence of stroke continued to diverge for the 2 groups out to 90-days postoperatively. Of the CS patients, 2.8% had prior carotid revascularization. These patients had no difference in odds of stroke when compared to patients who had not undergone revascularization (p=.522). Conclusions: ACDF patients with CS were found to be at significantly elevated odds of cardiac events and stroke (adverse outcomes associated with atherosclerotic burden), but not other assessed adverse outcomes. Surveillance of related symptoms through the perioperative period is importantly considered.
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