A Review Of Techniques Available For Perioperative Spinal Cord Monitoring For Thoracoabdominal Aortic Repair
Mostafa A. Soliman1, Maham Rahimi, MD PhD2, Anuj S. shah2, Yusuf Chauhan2, Stuart J. Corr2, Eric Peden2.
1Cairo university, Cairo, Egypt, 2Houston Methodist Hospital, Houston, TX, USA.
OBJECTIVES: Spinal cord ischemia is a devastating complication that can occur after open and endovascular thoracoabdominal aortic repair. This occurs despite various perioperative strategies including distal aortic perfusion, hybrid procedures with extra anatomical bypasses, and cerebrospinal fluid drainage. The inability to recognize in a timely manner spinal compromise remains a significant barrier to prevent paraplegia after the vascular intervention. As a result, maintaining continuous monitoring of spinal cord function and perfusion with detecting early changes are significant challenges.
METHODS: We have assessed literature data available on this topic and made a summary of available techniques and future perspectives. The search keywords were adapted to be used in PubMed, Scopus, and Google scholar databases. our search approach was to publish all relevant articles until August 2021.
RESULTS: Although spinal cord function can be monitored by evoked potentials during thoracoabdominal aortic repair, devastating spinal cord ischemia still occurs. There is a clear need for an easily applicable device that allows for real-time monitoring of the spinal cord during the perioperative period. In this regard, new other techniques have been published as potentially useful monitoring tools that could provide simple and effective monitoring of the spinal cord including Near-infrared spectroscopy, Contrast-enhanced ultrasound, MRI, Fiber optic monitoring of the spinal cord, and CSF biomarkers.
CONCLUSIONS: In this review, we present the technologies that are available in the literature for continuous monitoring spinal cord and discuss their advantages and limitations.
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