Spinal cord protection: development of a paraplegia-preventive solution.
We present a clinically available method to protect the spinal cord against ischemic or reperfusion injury and to prevent paraplegia after cross-clamping of the aorta. We separated 35 rabbits into five equal groups and clamped each animal's abdominal aorta distal to the left renal artery. We also occluded the aortas 2 cm above the iliac bifurcation for 45 minutes with inflated 5F balloon catheters. Through the catheter port distal to each balloon one of four different solutions was infused at 3 degrees C for 3 minutes at a rate of 5 mL/min (group I, uninfused control; group II, lactated Ringer's solution; group III, lactated Ringer's solution + 30 mg/kg of methylprednisolone; group IV, lactated Ringer's solution+methylprednisolone + 3 mL of 20% mannitol; group V, lactated Ringer's solution+methylprednisolone+mannitol + 10 mg/kg of vitamins E and C). We assessed the neurologic status of the hind limbs on the second postoperative day using Tarlov's criteria. The neurologic status in groups III, IV, and V was significantly superior to that of group I (p < 0.05, groups III versus I; p < 0.01, groups IV and V versus I). Spastic paraplegia occurred in 71% of group I, in 43% of group II, in 29% of group III, in 14% of group IV, and not at all in group V. The infusion of our specially blended solution with several spinal cord neuroprotective properties (hypothermia, methylprednisolone, mannitol, and vitamins E and C) achieved the best spinal cord protection against ischemic or reperfusion injury and prevented postoperative paraplegia.
Department of Surgery, Saga Medical School, Japan.
T
T
Ueno
K
K
Furukawa
Y
Y
Katayama
H
H
Suda
T
T
Itoh
D000818:Animals; D001012:Aorta, Abdominal; D001205:Ascorbic Acid / Q000627:therapeutic use*; D003250:Constriction; D004573:Electrolytes; D006614:Hindlimb / Q000294:innervation; D007036:Hypothermia, Induced; D007552:Isotonic Solutions / Q000627:therapeutic use*; D008353:Mannitol / Q000627:therapeutic use*; D008775:Methylprednisolone / Q000627:therapeutic use*; D009994:Osmolar Concentration; D010264:Paraplegia / Q000517:prevention & control*; D011817:Rabbits; D012039:Regional Blood Flow; D015427:Reperfusion Injury / Q000517:prevention & control*; D000077325:Ringer's Lactate; D013116:Spinal Cord / Q000098:blood supply*; D013997:Time Factors; D014810:Vitamin E / Q000627:therapeutic use*
D004573:Electrolytes; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D014810:Vitamin E; D008353:Mannitol; D001205:Ascorbic Acid; D008775:Methylprednisolone