Preventing spinal cord injury following thoracoabdominal aortic aneurysm repair: The battle to eliminate paraplegia
Cenea Kemp, Zihan Feng, Muhammad Aftab, T. Brett Reece
Abstract
Thoracoabdominal aortic intervention may be the most complex operation for cardiothoracic surgeons to perform and for patients to tolerate. The most feared complication of extensive thoracoabdominal procedures is spinal cord injury. Although understanding of this injury continues to evolve, surgeons have been able to reduce the incidence of paraplegia significantly over time through the use of multiple adjuncts, including staged aortic repair, maintenance of distal perfusion intraoperatively, management of intraoperative and postoperative hypotension, neuromonitoring, reimplantation of intercostal arteries, drainage of cerebral spinal fluid, intraoperative cooling, and pharmacologic adjuncts. However, significant burdens persist, including increased risk of mortality, increased perioperative hospital stays, increased hospital costs, increased need for rehabilitation admissions following discharge, and the resultant changes in quality of life for both the patients and their families. Further reduction in spinal cord injury, or optimally the elimination of paraplegia altogether, remains the ultimate goal for aortic surgeons performing complex aortic intervention.