Prevention and detection of spinal cord injury during thoracic and thoracoabdominal aortic repairs.
BACKGROUND
Spinal cord injury is a most dreaded and unpredictable complication. In this study, based on our experimental results in dogs and early clinical results, we reviewed the incidence of paraplegia and the detection of spinal cord injury.


METHODS
Eighty-two patients who underwent elective surgical repair of the descending thoracic and thoracoabdominal aorta over 17 years were subjects for this study. Sixty-two patients were male and 20 were female. Their mean age was 61.6 years (range, 17 to 81 years). Monitoring somatosensory evoked potentials (SEP) and measurement of mean distal aortic pressure and cerebrospinal fluid pressure were performed perioperatively.


RESULTS
Sixty patients had no ischemic change in SEP. In 17 patients with significant ischemic changes of SEP, SEP recovered by increasing spinal cord perfusion pressure to more than 40 mm Hg. Two patients with complete loss of SEP experienced paraplegia. One patient had delayed paraplegia.


CONCLUSIONS
These results strongly suggest that SEP, mean distal aortic pressure, cerebrospinal fluid pressure should be monitored during aortic cross-clamping. Maintaining spinal cord perfusion pressure at more than 40 mm Hg by increasing mean distal aortic pressure or withdrawal of cerebrospinal fluid is valuable for preventing paraplegia.
Wada
T
T
Department of Thoracic and Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, Japan. wadatora@hyo-med.ac.jp
Yao
H
H
Miyamoto
T
T
Mukai
S
S
Yamamura
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D000818:Animals; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001017:Aortic Coarctation / Q000601:surgery*; D004285:Dogs; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010264:Paraplegia / Q000175:diagnosis / Q000517:prevention & control*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D020760:Spinal Cord Ischemia / Q000175:diagnosis / Q000517:prevention & control*