A 67-year-old female patient with severe stenosis of the bulb of the right internal carotid artery, narrowing of the cervical space, and posterior protrusion of the intervertebral disc causing compression of the dural sac and the cervical medulla recently underwent carotid endarterectomy combined with cervical discectomy and intervertebral fusion at Xuanwu Hospital of Capital Medical University, after which the patient’s general numbness and weakness, dizziness, cotton-like sensation in both lower limbs and black haze disappeared completely. This combined procedure is the first of its kind in China and provides a preferred path for patients with carotid artery stenosis and disc stenosis to treat more than two diseases in one operation. Wu Hao, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University
The CTA showed that the patient had severe stenosis of the bulb of the right internal carotid artery, along with osteophytes of the cervical 4-7 vertebrae, narrowing of the cervical 4-5 and cervical 5-6 intervertebral spaces, posterior protrusion of the cervical 4-5 and cervical 5-6 intervertebral discs, and compression of the dural sac and cervical medulla. localized narrowing of the spinal canal at the level of the cervical 4-5 intervertebral space, etc.
The patient had two diseases at the same time, and traditional treatment required two operations, which not only caused great damage and was not conducive to postoperative recovery, but also made it very risky and technically demanding to perform discectomy + interbody fusion from the side of the narrowed internal carotid artery as an approach. After repeatedly studying the case, Dr. Liqun Jiao and Dr. Hao Wu of the neurosurgery department of the hospital decided to abandon their familiar surgical approaches and perform the right carotid endarterectomy combined with cervical discectomy + interbody graft fusion under the microscope using the same approach, which minimizes the patient’s injury, less bleeding and faster postoperative recovery. Because of carotid artery stenosis and plaque, it is very difficult to avoid straining the carotid artery intraoperatively to prevent the plaque from dislodging and causing thrombosis. The patient’s disc calcification was so severe that it could not be completely removed with a nucleus pulposus, but had to be removed bit by bit with a high-speed grinding drill to avoid damaging the spinal cord, and the endothelial stripping of the carotid artery under the microscope had to be done with extreme gentleness. The operator overcame these difficulties and the operation was completed successfully. The patient’s symptoms disappeared after the surgery and he was recently discharged from the hospital.
As of the date of publication, three cases of the same procedure have been completed with good postoperative results.