title: The use of lumbar drains in preventing spinal cord injury following thoracoabdominal aortic aneurysm repair: an updated systematic review and meta-analysis.
abstract: OBJECTIVE Paraplegia and paraparesis following aortic aneurysm repair occur at a substantially high rate and are often catastrophic to patients, their families, and the overall health care system. Spinal cord injury (SCI) following open thoracoabdominal aortic aneurysm (TAAA) repair is reported to be as high as 20% in historical controls. The goal of this study was to determine the impact of CSF drainage (CSFD) on SCI following TAAA repair. METHODS In August 2015 a systematic literature search was performed using clinicaltrials.gov , the Cochrane Library, PubMed/MEDLINE, and Scopus that identified 3478 articles. Of these articles, 10 met inclusion criteria. Random and fixed-effect meta-analyses were performed using both pooled and subset analyses based on study type. RESULTS The meta-analysis demonstrated that CSFD decreased SCI by nearly half (relative risk 0.42, 95% confidence interval 0.25-0.70; p = 0.0009) in the pooled analysis. This effect remained in the subgroup analysis of early SCI but did not remain significant in late SCI. CONCLUSIONS This meta-analysis showed that CSFD could be an effective strategy in preventing SCI following aortic aneurysm repair. Care should be taken to prevent complications related to overdrainage. No firm conclusions can be drawn about the newer endovascular procedures at the current time.
authors.affiliation: Department of Neurosurgery.
authors.forename: Nickalus R
authors.initials: NR
authors.lastname: Khan
authors.affiliation: College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee;
authors.forename: Zachary
authors.initials: Z
authors.lastname: Smalley
authors.affiliation: College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee;
authors.forename: Cody L
authors.initials: CL
authors.lastname: Nesvick
authors.affiliation: Department of Surgery, Metropolitan Group Hospitals, University of Illinois at Chicago, Illinois; and.
authors.forename: Siang Liao
authors.initials: SL
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery.|Semmes-Murphey Neurologic & Spine Institute, Memphis, Tennessee.
authors.forename: L Madison
authors.initials: LM
authors.lastname: Michael
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000601:surgery*; D002555:Cerebrospinal Fluid; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D013119:Spinal Cord Injuries / Q000209:etiology / Q000517:prevention & control*
keywords: CI = confidence interval; CSFD = CSF drainage; NNT = number needed to treat; NOS = Newcastle-Ottawa Scale; OCEBM = Oxford Center for Evidence-Based Medicine; OR = odds ratio; RCT = randomized controlled trial; RR = relative risk; SCI = spinal cord injury; TAAA = thoracoabdominal aortic aneurysm; TEVAR = thoracic endovascular aortic repair; aortic aneurysm; cerebrospinal fluid; df = degrees of freedom; endovascular; lumbar drain; spinal cord injury; vascular disorders