Spinal cord protection and thoracic aortic surgery.

Area of Science:

• Cardiovascular Surgery
• Neurology
• Vascular Surgery

Background:

• Spinal cord ischemia is a significant complication following thoracic and thoracoabdominal aortic aneurysm repair.
• Despite surgical advancements, preventing paraplegia remains a challenge.

Purpose of the Study:

• To identify risk factors for spinal cord ischemia.
• To review interventions for preventing and treating spinal cord ischemia.
• To reduce paraplegia, a severe complication of aortic aneurysm repair.

Main Methods:

• Review of risk factors including aneurysm extent, surgical approach, and perioperative hypotension.
• Evaluation of treatment strategies: augmenting spinal cord perfusion, cerebrospinal fluid drainage, and segmental artery reattachment.
• Emphasis on early detection via neurophysiologic monitoring and neurological examination.

Main Results:

• Aneurysm extent, open repair, prior aortic operations, and hypotension are key risk factors.
• Strategies like increased arterial pressure, CSF drainage, and artery reattachment improve perfusion.
• Early detection is crucial for timely intervention.

Conclusions:

• Permanent paraplegia can be prevented through early detection and prompt treatment of spinal cord ischemia.
• Interventions are justified by the high mortality and morbidity associated with paraplegia.
• Proactive management of spinal cord ischemia is essential in high-risk patients undergoing aortic repair.