Spinal cord ischemia is multifactorial: what is the best protocol?

Area of Science:

• Neurosurgery
• Vascular Surgery
• Cardiology

Background:

• Spinal cord ischemia (SCI) is a significant risk after thoracic or thoracoabdominal aortic disease repair.
• Despite advances in understanding, the incidence of paraparesis or paraplegia remains substantial.

Purpose of the Study:

• To review current understanding and management strategies for spinal cord ischemia following aortic repair.
• To emphasize the importance of a multimodal approach and prompt intervention.

Main Methods:

• Review of existing literature on spinal cord ischemia prevention and treatment modalities.
• Discussion of open and endovascular repair techniques and their impact on SCI.
• Emphasis on collateral circulation and diagnostic tool advancements.

Main Results:

• No significant reduction in SCI rates observed with the routine use of endovascular techniques.
• Various treatment modalities show potential in improving spinal cord perfusion via collateral pathways.
• Early and aggressive management is key due to the potential reversibility of SCI.

Conclusions:

• A multimodal strategy is advocated for preventing and managing SCI after aortic procedures.
• Improved preoperative assessment of spinal vascular networks is essential for better surgical planning.
• Prompt intervention for SCI can improve outcomes by leveraging collateral circulation.