Spinal cord perfusion after extensive segmental artery sacrifice: can paraplegia be prevented?

Christian D. Etz, Tobias M. Homann, Konstadinos A. Plestis, Ning Zhang, Maximilian Luehr, Donald J. Weisz, George Kleinman, Randall B. Griepp

Research output: Contribution to journalArticlepeer-review

59 Scopus citations

Abstract

Objective: Understanding the ability of the paraspinal anastomotic network to provide adequate spinal cord perfusion pressure (SCPP) critical for both surgical and endovascular repair of thoracoabdominal aortic aneurysms (TAAA). Methods: To monitor pressure in the collateral circulation, a catheter was inserted into the distal end of the divided first lumbar segmental artery (SA) of 10 juvenile Yorkshire pigs (28.9 ± 3.8 kg). SA pairs from T3 through L5 were serially sacrificed at 32 °C; SCPP and function - using motor-evoked potentials (MEPs) - were continuously monitored until 1 h after clamping the last SA. Intermittent aortic and SCPP monitoring was continued for 5 days postoperatively, along with evaluation of motor function. Results: A mean of 14.4 ± 0.7 SAs were sacrificed without loss of MEP. SCPP (mmHg) dropped from 68 ± 7 before SA clamping (77% of aortic pressure) to 22 ± 6 at end clamping, and 21 ± 4 after 1 h, reaching its lowest point - 19 ± 4 - after 5 h. Postoperatively, SCPP recovered to 33 ± 6 at 24 h; 42 ± 10 at 48 h; 56 ± 14 at 72 h; 62 ± 15 at 96 h, returning to baseline (63 ± 20) at 120 h. Despite comparable SCPP patterns, four pigs did not fully regain the ability to stand. Six animals recovered: two could stand and four could walk. Conclusions: Interruption of all SAs at 32 °C in this pig model results in a spectrum of cord injury, with normal function in a majority of pigs postoperatively. The short duration of low SCPP suggests that hemodynamic manipulation lasting only 24-48 h may allow routine complete preservation of normal cord function despite sacrifice of all SAs.

Original languageEnglish (US)
Pages (from-to)643-648
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume31
Issue number4
DOIs
StatePublished - Apr 2007

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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