Delayed onset of neurologic deficit: significance and management

As contemporary adjuncts have substantially reduced the overall incidence of paraplegia and paraparesis after the surgical repair of thoracoabdominal aortic aneurysm, delayed-onset neurologic deficit has emerged as a significant clinical entity. It is generally agreed that neurologic deficits are attributable to the duration of spinal cord ischemia sustained during aortic cross-clamping. Factors known to increase the risk of spinal cord injury include the aneurysm extent, aortic cross-clamp time, aneurysm rupture, and associated acute aortic dissection. Clinically and experimentally, studies have shown different adjuncts to improve spinal cord protection, providing further insights into the pathophysiology of spinal cord ischemia. However, the pathophysiology of delayed-onset spinal cord deficit after thoracoabdominal aortic aneurysm repair remains largely controversial. This review discusses the significance and management of delayed-onset neurologic deficit.