SPINAL-CORD DAMAGE IN SURGERY OF ABDOMINAL-AORTA

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  • 1 January 1978
    • journal article
    • research article
    • Vol. 83  (1) , 38-56
Abstract
The incidence, etiology, and clinical manifestations of spinal cord damage after abdominal aortic operations and abdominal aortography are defined on grounds of experience and of a survey of the pertinent literature. From experience, the incidence of cord damage was 0.25% (3 of 3164) after abdominal aortic operations and 0.01% (2 of 17,494) after abdominal aortography. As regards postoperative cord complications in the series, they occurred only in cases of aneurysm, were 10 times more common in ruptured than in unruptured aneurysms, and the neurological loss usually was complete flaccid paraplegia (5 of 8 or 62%) with high mortality (3 of 8 or 38%), and rare partial (2 of 8 or 25%) or complete (1 of 8 or 13%) recovery. Recovery was more likely the lesser than neurological loss. The cause of postoperative spinal cord damage was ischemia resulting from the interruption of a critical radicular artery at the lower thoracic or high lumbar vertebral levels in the presence of anomalously located greater radicular or infrarenal radicular arteries. High aortic clamping and hypotension increased the probability of this occurrence, which essentially was unpredictable and, therefore, unavoidable. In postaortographic cases the cord damage is more variable in its extent, and its cause is a chemical insult brought about by flooding the anterior spinal artery with contrast medium to which the patient probably is hypersensitive. In both groups treatment of the established clinical picture (paraplegia) is confined to support and rehabilitation.