Ischemia of the spinal cord in aortic surgery

Spinal cord ischemia remains the most impressive and colliding complication following open surgical and endovascular aortic procedures. Paraparesis and paraplegia are devastating, having a major invalidating impact on the patient’s life. For the surgeon and the entire team this dramatic adverse event causes a significant concussion.
The author has compiled all available knowledge, information, research and clinical data on spinal cord ischemia after aortic surgery. Following historical reflections he describes the classical anatomy theory, originally addressed by Adamkiewicz. The differences between acute and delayed paraplegia have extensively been explained, including the different strategies to minimize cord ischemia. The author also describes the techniques to assess spinal cord integrity, preconditioning and the approaches to increase and develop collateral pathways. Finally, he discusses the experience after endovascular treatment of descending and thoraco-abdominal aortic aneurysms as well as measures to reduce the incidence of spinal cord ischemia. This book is a comprehensive overview on spinal cord ischemia following aortic procedures and helps in understanding the complexity of the puzzle. It also motivates to continue basic and clinical research in the battle against this terrible medical complication.