Turkish Neurosurgery
Is there a risk of stroke during anterior cervical discectomy? A randomized controlled trial.
Nevin Esra Gümüş1, Tuba Kuvvet Yoldaş2, Vaner Köksal3, Ahmet Karkucak4, Birol Bayraktar 3
1Samsun Training and Research Hospital, Anesthesia Clinic, Samsun ,
2Health Sciences University, Tepecik Training and Research Hospital, Anesthesia Clinic, İzmir,
3Samsun University Medical Faculty, Neurosurgery , Samsun,
4Samsun Great Anatolian Hospital, Neurosurgery, Samsun,
DOI: 10.5137/1019-5149.JTN.44169-23.3

Aim:The positioning and retraction technique employed to reach the anterior cervical vertebral surface during anterior cervical discectomy (ACD) has the potential to impair carotid blood flow, thereby increasing the risk of cerebral ischemia. This clinical trial was organized as there is insufficient evidence to support this theory in the literature.Material and Methods:: In this prospective comparative study, which was conducted under assessor-blind conditions, a cohort of 48 adult patients with ASA I-II classification who underwent ACD under general anesthesia was carefully assessed and equally divided into two groups as self-retaining retractor group and hand-held retractor group. Alongside routine anesthesia monitoring, cerebral oximetry monitoring was implemented for all patients. A total of 7 measurements were obtained at various stages, including preoperative, during anesthesia induction, surgical positioning, surgical retraction, release of retractors, after correction of extension position, and prior to extubation. The primary outcome of this study was to examine the impact of neck position and surgical retraction on brain perfusion, as measured by regional cerebral oximetry.Results:Sociodemographic information, duration of operation, hemodynamic parameters, rScO2, and MMSE values did not differ significantly between the two groups. In both groups, the bilateral rScO2 decreased significantly with positioning and the left rScO2 decreased significantly following the installation of the retractor. Only the left rScO₂ increased significantly upon the release of both retractors. Following the correction of the neck position, bilateral rScO₂ increased significantly in both groups (p<0.001). Conclusion:Left carotid artery rScO₂ was shown to decrease considerably as a result of the retractors\' indirect effect. After extending the head and neck, bilateral rScO₂ values decreased significantly in both groups. Nonetheless, this decline did not lead to a reduction in brain perfusion substantial enough to cause ischemia. The lack of a statistically significant difference between the groups suggests that may not compromise brain perfusion.

Corresponding author : Vaner Köksal