Cerebral Thromboembolic Events During Anterior Cervical Spine Surgery: Retrospective Case Series Study With Diffusion-Weighted Magnetic Resonance Imaging Follow-up in the Immediate Postoperative Period

We evaluated the efficacy of diffusion-weighted magnetic resonance imaging (DW-MRI) in detecting perioperative cerebral thromboembolic events after anterior cervical discectomy and fusion (ACDF). This retrospective case series included 51 consecutive patients that underwent ACDF. To assess baseline presence of plaque or stenosis, all patients were assessed for risk factors of cerebrovascular events and underwent carotid ultrasound preoperatively and cerebral DW-MRI was performed in all patients postoperatively, with areas of high signal intensity interpreted as a cerebral thromboembolic event. One male patient who underwent a C4/5 ACDF had a focal diffusion abnormality on DW-MRI concerning for cerebral thromboembolic events in the right posterior cerebral artery territory. He remained asymptomatic and did not display related neurological symptoms, such as visual deficits. Asymptomatic cerebral thromboembolic events can be detected by DW-MRI after ACDF. The incidence of such events remains very rare despite the direct manipulation and associated alteration of common carotid artery flow dynamics.