Prevention and Management of Spinal Cord Ischemia After Aortic Surgery: An Umbrella Review
<b>Background/Objectives:</b> Spinal cord injury is a devastating complication of aortic surgery, with significant morbidity and mortality. This review aimed to summarize the current literature on preventing and managing spinal cord ischemia after open and endovascular aortic repair. <...
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2025-04-01
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| author | Alexandros G. Brotis Adamantios Kalogeras Metaxia Bareka Eleni Arnaoutoglou Kostas Spanos Miltiadis Matsagkas Kostas N. Fountas |
| author_facet | Alexandros G. Brotis Adamantios Kalogeras Metaxia Bareka Eleni Arnaoutoglou Kostas Spanos Miltiadis Matsagkas Kostas N. Fountas |
| author_sort | Alexandros G. Brotis |
| collection | DOAJ |
| description | <b>Background/Objectives:</b> Spinal cord injury is a devastating complication of aortic surgery, with significant morbidity and mortality. This review aimed to summarize the current literature on preventing and managing spinal cord ischemia after open and endovascular aortic repair. <b>Methods</b>: We conducted a comprehensive review of PubMed, Scopus, and the Web of Science, focusing on systematic reviews and meta-analyses of the pathophysiology, risk factors, and strategies for mitigating the risk of spinal cord injury after aortic repair. We assessed the quality of the reporting for the eligible studies using the AMSTAR-2 tool and evaluated the strength of the evidence using the GRADE approach. Due to the absence of homogeneous clinical data, the evidence was synthesized in a narrative form. <b>Results:</b> Spinal cord ischemia can occur after both open and endovascular aortic repair, with a higher incidence reported in more extensive thoraco-abdominal aortic aneurysm repairs. The underlying pathogenesis is largely understudied. Several preventive strategies have been partially investigated, including cerebrospinal fluid drainage, hypothermia, and distal aortic perfusion. While the employment of neuromonitoring has been established in spine surgery, its efficacy in aortic repair remains uncertain due to confounding factors like hypothermia, anesthesia medications, and cardiopulmonary bypass. The prompt management of spinal cord complications is crucial to optimizing outcomes. No clear treatment algorithm has been universally adopted. <b>Conclusions:</b> Spinal cord ischemia remains a major challenge in aortic surgery, with a significant impact on patient outcomes. Further research is needed to elucidate the relevant pathophysiology and develop more effective intraoperative monitoring and management strategies. |
| format | Article |
| id | doaj-art-8b33257d38ca47909b6dc8f8b563c833 |
| institution | DOAJ |
| issn | 2076-3425 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Brain Sciences |
| spelling | doaj-art-8b33257d38ca47909b6dc8f8b563c8332025-08-20T03:14:16ZengMDPI AGBrain Sciences2076-34252025-04-0115440910.3390/brainsci15040409Prevention and Management of Spinal Cord Ischemia After Aortic Surgery: An Umbrella ReviewAlexandros G. Brotis0Adamantios Kalogeras1Metaxia Bareka2Eleni Arnaoutoglou3Kostas Spanos4Miltiadis Matsagkas5Kostas N. Fountas6Department of Neurosurgery and Medical, Faculty of Medicine, School of Thessaly Health Sciences, University of Thessaly, 41500 Larissa, GreeceDepartment of Neurosurgery, University Hospital of Larissa, 41500 Larissa, GreeceDepartment of Anaesthesiology, Medical Faculty of Medicine, School of Thessaly Health Sciences, University of Thessaly, 41500 Larissa, GreeceDepartment of Anaesthesiology, Medical Faculty of Medicine, School of Thessaly Health Sciences, University of Thessaly, 41500 Larissa, GreeceDepartment of Vascular Surgery, Medical Faculty of Medicine, School of Thessaly Health Sciences, University of Thessaly, 41500 Larissa, GreeceDepartment of Vascular Surgery, Medical Faculty of Medicine, School of Thessaly Health Sciences, University of Thessaly, 41500 Larissa, GreeceDepartment of Neurosurgery, Medical Faculty of Medicine, School of Thessaly Health Sciences, University of Thessaly, 41500 Larissa, Greece<b>Background/Objectives:</b> Spinal cord injury is a devastating complication of aortic surgery, with significant morbidity and mortality. This review aimed to summarize the current literature on preventing and managing spinal cord ischemia after open and endovascular aortic repair. <b>Methods</b>: We conducted a comprehensive review of PubMed, Scopus, and the Web of Science, focusing on systematic reviews and meta-analyses of the pathophysiology, risk factors, and strategies for mitigating the risk of spinal cord injury after aortic repair. We assessed the quality of the reporting for the eligible studies using the AMSTAR-2 tool and evaluated the strength of the evidence using the GRADE approach. Due to the absence of homogeneous clinical data, the evidence was synthesized in a narrative form. <b>Results:</b> Spinal cord ischemia can occur after both open and endovascular aortic repair, with a higher incidence reported in more extensive thoraco-abdominal aortic aneurysm repairs. The underlying pathogenesis is largely understudied. Several preventive strategies have been partially investigated, including cerebrospinal fluid drainage, hypothermia, and distal aortic perfusion. While the employment of neuromonitoring has been established in spine surgery, its efficacy in aortic repair remains uncertain due to confounding factors like hypothermia, anesthesia medications, and cardiopulmonary bypass. The prompt management of spinal cord complications is crucial to optimizing outcomes. No clear treatment algorithm has been universally adopted. <b>Conclusions:</b> Spinal cord ischemia remains a major challenge in aortic surgery, with a significant impact on patient outcomes. Further research is needed to elucidate the relevant pathophysiology and develop more effective intraoperative monitoring and management strategies.https://www.mdpi.com/2076-3425/15/4/409spinal cord ischemiaaortic surgeryincidencerisk factorspreventionearly detection |
| spellingShingle | Alexandros G. Brotis Adamantios Kalogeras Metaxia Bareka Eleni Arnaoutoglou Kostas Spanos Miltiadis Matsagkas Kostas N. Fountas Prevention and Management of Spinal Cord Ischemia After Aortic Surgery: An Umbrella Review Brain Sciences spinal cord ischemia aortic surgery incidence risk factors prevention early detection |
| title | Prevention and Management of Spinal Cord Ischemia After Aortic Surgery: An Umbrella Review |
| title_full | Prevention and Management of Spinal Cord Ischemia After Aortic Surgery: An Umbrella Review |
| title_fullStr | Prevention and Management of Spinal Cord Ischemia After Aortic Surgery: An Umbrella Review |
| title_full_unstemmed | Prevention and Management of Spinal Cord Ischemia After Aortic Surgery: An Umbrella Review |
| title_short | Prevention and Management of Spinal Cord Ischemia After Aortic Surgery: An Umbrella Review |
| title_sort | prevention and management of spinal cord ischemia after aortic surgery an umbrella review |
| topic | spinal cord ischemia aortic surgery incidence risk factors prevention early detection |
| url | https://www.mdpi.com/2076-3425/15/4/409 |
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