title: Spinal cord injury following thoracic and thoracoabdominal aortic repairs.
abstract: OBJECTIVE
  To discuss the currently available approaches to prevent spinal cord injury during thoracic and thoracoabdominal aortic repairs.
  
  
  METHODS
  We carried out a PubMed search up to 2013 using the Medical Subject Headings: "aortic aneurysm/surgery" and "spinal cord ischemia"; "aortic aneurysm, thoracic/surgery" and "spinal cord ischemia"; "aneurysm/surgery" and "spinal cord ischemia/cerebrospinal fluid"; "aortic aneurysm/surgery" and "paraplegia". All 190 original articles satisfying our inclusion criteria were analyzed for incidence, predictors, and other pertinent variables related to spinal cord injury, and we compared the results in recent publications with those in earlier reports.
  
  
  RESULTS
  The mean age of the 38,491 patients was 65.3 ± 4.9 years. The overall incidence of paraplegia and/or paraparesis was 7.1% ± 6.1% (range 0%-32%). The incidence of spinal cord injury before 2000, from 2001 to 2007, and 2008-2013 was 9.0% ± 6.7%, 7.0% ± 6.1%, and 5.9% ± 5.2%, respectively (p = 0.019). Various predictors of spinal cord injury were identified, extent of disease being the most common. Modification of surgical techniques, use of adjuncts, and better understanding of spinal cord perfusion physiology were attributed to the decrease in postoperative spinal cord injury in recent years.
  
  
  CONCLUSIONS
  Spinal cord injury after thoracic and thoracoabdominal aortic repair poses a real challenge to cardiovascular surgeons. However, with evolving surgical strategies, identification of predictors, and use of various adjuncts over the years, the incidence of spinal cord injury after thoracic/thoracoabdominal aortic repair has declined. Embracing a multimodality approach offers a good insight into combating this grave complication.
authors.affiliation: Department of Cardiac Surgery, University of Tokyo, Tokyo, Japan.
authors.forename: Nirmal
authors.initials: N
authors.lastname: Panthee
authors.affiliation: Department of Cardiac Surgery, University of Tokyo, Tokyo, Japan ono-tho@h.u-tokyo.ac.jp.
authors.forename: Minoru
authors.initials: M
authors.lastname: Ono
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020335:Paraparesis / Q000209:etiology; D010264:Paraplegia / Q000209:etiology; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D016896:Treatment Outcome
keywords: Aortic aneurysm; cerebrospinal fluid; evoked potentials; hypothermia; paraplegia; spinal cord ischemia