Embolism is emerging as a major cause of spinal cord injury after descending and thoracoabdominal aortic repair with a contemporary approach: magnetic resonance findings of spinal cord injury

Abstract

Objectives: We reviewed magnetic resonance (MR) findings of the spinal cord in patients who had a spinal cord injury after descending and thoracoabdominal aortic repair, to speculate the specific cause of the injury.

Methods: Between 2000 and 2012, 746 patients underwent descending or thoracoabdominal aortic surgery: 480 received an open repair with adjuncts of spinal cord protection [distal perfusion, cerebrospinal fluid (CSF) drainage, reattachment of intercostal arteries and hypothermia] and 266 received an endovascular repair. Twenty-six (3.5%) suffered a spinal cord injury. Of these, 18 (14 open repair and 4 endovascular repair) underwent postoperative spinal cord MRI. Preoperative identification of the Adamkiewicz artery (ARM) was obtained in all patients except 1. Aortic pathology was dissection in 2 and non-dissection in 16 patients.

Results: There were 3 types MRI finding: sporadic infarction involving a range of spinal cord (sporadic); focal and asymmetrical infarction within a few segments of vertebra (focal); and diffuse and symmetrical infarction around the level of the ARM (diffuse). In endovascular repair, sporadic infarction was observed in all patients (4 of 4). In open repair, sporadic infarction was observed in 3 (21%), focal infarction in 7 (50%) and diffuse infarction in 4 (29%). In all patients who had sporadic or focal infarction, the aortic pathology was non-dissection.

Conclusions: From these findings, embolism is 1 of the major causes of spinal cord injury in the era of adjuncts to optimize spinal cord haemodynamics during aortic repair.

Keywords: Aortic repair; Embolism; Spinal cord injury.