Embolism is emerging as a major cause of spinal cord injury after descending and thoracoabdominal aortic repair with a contemporary approach: magnetic resonance findings of spinal cord injury.
OBJECTIVE
We reviewed magnetic resonance (MR) findings of the spinal cord in patients who had a spinal cord injury after descending and thoracoabdominal aortic repair, to speculate the specific cause of the injury.


METHODS
Between 2000 and 2012, 746 patients underwent descending or thoracoabdominal aortic surgery: 480 received an open repair with adjuncts of spinal cord protection [distal perfusion, cerebrospinal fluid (CSF) drainage, reattachment of intercostal arteries and hypothermia] and 266 received an endovascular repair. Twenty-six (3.5%) suffered a spinal cord injury. Of these, 18 (14 open repair and 4 endovascular repair) underwent postoperative spinal cord MRI. Preoperative identification of the Adamkiewicz artery (ARM) was obtained in all patients except 1. Aortic pathology was dissection in 2 and non-dissection in 16 patients.


RESULTS
There were 3 types MRI finding: sporadic infarction involving a range of spinal cord (sporadic); focal and asymmetrical infarction within a few segments of vertebra (focal); and diffuse and symmetrical infarction around the level of the ARM (diffuse). In endovascular repair, sporadic infarction was observed in all patients (4 of 4). In open repair, sporadic infarction was observed in 3 (21%), focal infarction in 7 (50%) and diffuse infarction in 4 (29%). In all patients who had sporadic or focal infarction, the aortic pathology was non-dissection.


CONCLUSIONS
From these findings, embolism is 1 of the major causes of spinal cord injury in the era of adjuncts to optimize spinal cord haemodynamics during aortic repair.
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan hirtanak@hsp.ncvc.go.jp.
Hiroshi
H
Tanaka
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Kenji
K
Minatoya
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Hitoshi
H
Matsuda
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Hiroaki
H
Sasaki
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Yutaka
Y
Iba
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Tatsuya
T
Oda
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Junjiro
J
Kobayashi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D004617:Embolism / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D007238:Infarction / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D013116:Spinal Cord / Q000473:pathology*; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D013812:Therapeutics; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
Aortic repair; Embolism; Spinal cord injury