Postoperative Spinal Cord Ischemia Monitoring: A Review of Techniques Available after Endovascular Aortic Repair

Abstract

BackgroundSpinal cord ischemia is one of the complications that can occur after open and endovascular thoracoabdominal aortic repair. This occurs despite various perioperative approaches, including distal aortic perfusion, hybrid procedures with extra anatomical bypasses, motor-evoked potential, and cerebrospinal fluid drainage. The inability to recognize spinal ischemia in a timely manner remains a devastating complication after thoracoabdominal aortic repair. ObjectivesThis review aims to look at novel technologies that are designed for continuous monitoring to detect early changes that signal the development of spinal cord ischemia and to discuss their benefits and limitations. MethodsWe conducted a systematic review of the technologies available for continuous monitoring in the intensive care unit (ICU) for early detection of spinal cord ischemia. Studies were eligible for inclusion if they used different technologies for monitoring spinal ischemia during the postoperative period. All articles that were not available in English were excluded. To ensure that all relevant articles were included, no other significant restrictions were imposed. ResultsWe identified 59 studies from outset to December 2022 to be included in our study. New techniques have been studied as potentially useful monitoring tools that could provide simple and effective monitoring of the spinal cord. These include Near-infrared spectroscopy, Contrast-enhanced ultrasound, Magnetic Resonance Imaging, fiber optic monitoring of the spinal cord, and CSF biomarkers. ConclusionDespite the development of new techniques to monitor for postoperative spinal cord ischemia, their use remains limited. We recommend more future research to ensure rapid intervention for our patients.