European Spine Journal

, Volume 28, Issue 3, pp 463–469 | Cite as

Cerebral ischaemia following anterior upper thoracic spinal surgery utilizing a partial manubrial resection

  • David Christopher KieserEmail author
  • Derek Thomas Cawley
  • Takashi Fujishiro
  • Cecile Roscop
  • Louis Boissiere
  • Ibrahim Obeid
  • Olivier Gille
  • Jean-Marc Vital
  • Vincent Pointillart
Original Article



Firstly, to describe two cases of cerebral ischaemia complicating anterior upper thoracic spinal surgery and define the likely cause of this complication. Secondly, to describe preventative measures and the effect these have had in reducing this complication within our institution.


Firstly, a review of two cases of cerebral ischaemia complicating anterior upper thoracic spinal surgery utilizing a partial manubrial resection. Secondly, cadaveric dissections of the carotid arteries to determine the effect of neck positioning and aortic arch retraction during a simulated procedure. Thirdly, a retrospective review of 65 consecutive cases undergoing this procedure and assessment of the rate of this complication before and after the adoption of preventative measures.


Two cases of carotid artery territory cerebral ischaemia, without radiographic evidence of carotid or cardiac pathology were identified in 50 consecutive cases prior to the implementation of preventative measures. These patients revealed fluctuating hemodynamic instability after placement of the inferior retractor. Cadaveric dissection reveals significant carotid artery traction particularly with neck extension. Since the adoption of preventative measures, no cases of cerebral ischaemia have been encountered.


Cerebral ischaemia is a potential complication of anterior upper thoracic spinal surgery requiring retraction of the aortic arch. This most likely occurs from carotid stenosis due to aortic retraction and therefore, may be reduced by positioning the patient with neck flexion. Continuous non-invasive monitoring of cerebral saturation, as well as actively monitoring for hemodynamic instability and reduced carotid pulsation after retractor placement, allows for early detection of this complication. If detected, perfusion can be easily restored by reducing the retraction of aortic arch.


Cerebral ischaemia Thoracic spine Spinal metastases Anterior thoracic Carotid artery Corpectomy Upper thoracic 



Glynny Kieser for her editorial input.

Compliance with ethical standards

Conflict of interest

None of the authors have any potential conflict of interest.




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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • David Christopher Kieser
    • 1
    Email author
  • Derek Thomas Cawley
    • 2
  • Takashi Fujishiro
    • 2
  • Cecile Roscop
    • 2
  • Louis Boissiere
    • 2
  • Ibrahim Obeid
    • 2
  • Olivier Gille
    • 2
  • Jean-Marc Vital
    • 2
  • Vincent Pointillart
    • 2
  1. 1.Department of Orthopaedic Surgery and Musculoskeletal Medicine, Canterbury School of Medicine, Canterbury District Health BoardUniveristy of OtagoChristchurchNew Zealand
  2. 2.L’Institut de la Colonne Vertébrale, CHU PellegrinBordeauxFrance

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