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Updated: Jul 20, 2026
05:59
Reproducable Paraplegia by Thoracic Aortic Occlusion in a Murine Model of Spinal Cord Ischemia-reperfusion
Published on: March 3, 2014
Paralysis after aortic surgery: in search of lost cord function
1Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA. svenssl@ccf.org
Summary
Paralysis after complex aortic surgery risk significantly reduced by implementing protective strategies like hypothermia and cerebrospinal fluid drainage. These methods lowered paralysis rates from 41% to under 4% in recent studies.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Surgical Innovation
Background:
- High rates of paralysis (up to 41%) historically followed complex thoracoabdominal aortic operations.
- Spinal cord ischemia during aortic cross-clamping was a primary cause of post-operative paralysis.
Purpose of the Study:
- To investigate the pathophysiology of aortic cross-clamping and the causes of paralysis.
- To develop and validate protective strategies to reduce paralysis after aortic surgery.
Main Methods:
- Established a chacma baboon (papio ursinus) animal model to study spinal cord vascular anatomy.
- Developed and utilized motor evoked responses for monitoring spinal cord function.
- Conducted prospective and randomized clinical studies to evaluate protective measures.
Main Results:
- Identified several protective strategies: intrathecal papaverine with cerebrospinal fluid, systemic hypothermia, minimized ischemia time, sequential segmental repair, re-attachment of intercostal arteries, prolonged cerebrospinal fluid drainage, and post-operative hypertension.
- Reduced the risk of permanent paralysis to 3.1%-3.8% in recent patient series.
Conclusions:
- A combination of specific surgical techniques and perioperative management significantly mitigates the risk of paralysis after complex aortic repair.
- The developed strategies represent a major advancement in patient safety for thoracoabdominal aortic surgery.
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