Introduction: Spine surgeons are increasingly required to operate on patients of advanced age who are symptomatic from degenerative cervical spine conditions. Elderly patients undergoing anterior cervical spine procedures may be at increased risk for carotid thrombosis due to an increased incidence of atherosclerotic disease. Post operative development of carotid thrombosis in elderly patients undergoing anterior cervical spine procedures (ACSP) has been described in case reports , however there are no comprehensive reports evaluating the incidence of significant carotid stenosis in elderly patients undergoing (ACSP) .Some authors have recommended pre-operative ultrasound in patients who may be at high risk for carotid stenosis. In this study we preoperatively evaluated a cohort of elderly patients undergoing (ACSP) with bilateral carotid ultrasound(BCS).

Methods: During the period 2012-2015 25 patients were scheduled for (ACSP) and underwent preoperative(BCS). Inclusion criteria was age >65. All patients were examined preoperatively for the presence of a carotid bruit.

Results: 25 patients underwent preoperative(BCS). There were 15 women and 10 men. The age range was 65 to 82.None of the patients were determined to have a carotid bruit on physical examination. One patient was found to have greater than 70% stenosis on (BCS). This finding was not confirmed on CT angiography. None of the other patients were found to have significant stenosis on (BCS).

Conclusions: Anterior cervical discectomy and fusion (ACDF) is a safe procedure. Carotid thrombosis after (ACDF)is very rare. Cerebrovascular injuries after (ACSP) in a series of 10,416 was found to be only 0.13%. However, carotid retraction during (ACDF) can alter flow by decreasing vessel cross- sectional area. Risks factors for post-operative thrombosis include corpectomy procedures and prolonged carotid retraction for surgical exposure. Based on this small study, routine preoperative (BCS) can not be recommended.

Patient Care: This research will assist surgeons in identifying risk factors for iatrogenic stroke after (ACSP).

Learning Objectives: 1.Evaluate the role of (BCS) in the preoperative evaluation of patients undergoing (ACSP). 2. Identify risk factors for development of carotid thrombosis after (ACSP).

References: 1.Chozick BS, Watson P, Greenblatt SH. Internal Carotid Artery Thrombosis After Cervical Corpectomy. Spine 1994;19:2230-2232. 2.Inamasu J, Guiot BH. iatrogenic carotid artery injury in neurosurgery. Neurosurg. Rev. 2005;28:239-247 3.Pollard ME, Little PW. Changes in Carotid Artery Blood Flow During Anterior Cervical Spine Surgery.Spine 2002;27: 152-155