Unexplained Perioperative Vertebrobasilar Stroke in a Patient Undergoing Anterior Cervical Decompression and Disc Arthroplasty

BACKGROUND: Vertebrobasilar stroke associated with the anterior approach to the cervical spine is rare and has not been reported in cervical disc arthroplasty surgery. We report the case of a 60-year-old patient who underwent cervical disc arthroplasty at C4-5, C5-6 and C6-7. Postoperatively, due to symptoms and signs of a cerebellar stroke, magnetic resonance imaging of the brain was obtained confirming this diagnosis. Despite thorough investigation no specific identifiable cause for the stroke has been identified. We hypothesis an unrecognised period of intraoperative hypotension may have caused a temporary reduction in vertebrobasilar blood flow. METHODS: A retrospective review of the patient's case notes and a focused review of literature has been performed. RESULTS: Now two years postoperatively the patient has regained full power but has residual problems with balance. She has neuralgic pain down the right side of her body which following investigation is believed to result from the stroke. CONCLUSIONS / LEVEL OF EVIDENCE: Surgeons should be aware vertebrobasilar stroke is a possible rare perioperative complication associated with anterior cervical decompression and disc arthroplasty. Level V.