Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2021; 9(28): 8602-8608
Published online Oct 6, 2021. doi: 10.12998/wjcc.v9.i28.8602
Delayed massive cerebral infarction after perioperative period of anterior cervical discectomy and fusion: A case report
Fei Jia, Chuan-Chao Du, Xiao-Guang Liu
Fei Jia, Chuan-Chao Du, Xiao-Guang Liu, Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
Author contributions: Jia F contributed to the conceptualization, investigation, and project administration, and wrote the original draft; Du CC contributed to the data curation, resources, formal analysis, and visualization, and reviewed and edited the manuscript; Liu XG contributed to methodology and supervision; all authors approved the final manuscript.
Supported by Capital’s Funds for Health Improvement and Research, No. 2020-2-4091.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Xiao-Guang Liu, MD, Professor, Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Street, Beijing 100191, China.
Received: May 25, 2021
Peer-review started: May 25, 2021
First decision: June 24, 2021
Revised: July 8, 2021
Accepted: August 12, 2021
Article in press: August 12, 2021
Published online: October 6, 2021

Cerebral infarction is an extremely rare postoperative complication of anterior cervical discectomy and fusion (ACDF), particularly in the delayed setting. We present a case who had a sudden stroke on day 18 after surgery. By sharing our experience with this case, we hope to provide new information about stroke after anterior cervical surgery.


We present the case of a 61-year-old man with more than 20 years of hypertension and 14 years of coronary heart disease who had suffered a stroke 11 years ago. The patient was admitted for a multiple ACDF due to symptoms of cervical spondylotic myelopathy and had a sudden stroke on day 18 after surgery. Imaging findings showed a large-area infarct of his left cerebral hemisphere and thrombosis in his left common carotid artery. With the consent of his family, the thrombus was removed and a vascular stent was implanted through an interventional operation. Forty days later, the patient was transferred to a rehabilitation hospital for further treatment. He had normal consciousness but slurred speech at the 1-year follow-up evaluation. The motor and sensory functions of his hemiplegic limbs partially recovered.


This case illustrated that a postoperative stroke related to anterior cervical surgery may be attributed to prolonged carotid retraction and might have a long silent period. Preventive measures include careful preoperative and postoperative examination for high-risk patients as well as gentle and intermittent retraction of carotid artery sheath during operation.

Keywords: Anterior cervical discectomy and fusion, Cerebral infarction, Carotid artery, Postoperative complication, Case report

Core Tip: A postoperative stroke related to anterior cervical surgery is rare and may have a long silent period during which a carotid thrombus had formed at the surgical site. Preventive measures include gentle and intermittent retraction of carotid artery sheath during surgery, careful preoperative risk assessment and grading, and continuous postoperative monitoring of blood pressure, coagulation state, and condition changes of special patients.