Spinal Cord Injury Prevention and Management

Abstract

Spinal cord ischemia (SCI) is a devastating complication that can affect patients undergoing aortic surgery. The incidence of SCI can vary, but it is most frequently encountered with repair or exclusion of more extensive thoracoabdominal aortic aneurysms. The etiology of SCI is likely multifactorial, but one of the leading mechanisms of its occurrence is occlusion of the segmental spinal arteries, such as the intercostal and lumbar arteries, in the absence of sufficient collateral flow. Many efforts are underway to develop prevention and treatment paradigms to help limit this complication. Some interventions such as the use of a spinal drain or staging of aortic repair may help to reduce the incidence and severity of SCI. Pharmacologic agents may show promise, but have not had as dramatic an effect. Careful operative planning and meticulous perioperative care are mandatory in the management of the at risk patient. Unfortunately, those patients that develop significant paraplegia ultimately have poorer long-term outcomes compared to those patients that are spared these events.