Cold spinoplegia and transvertebral cooling pad reduce spinal cord injury during thoracoabdominal aortic surgery Mitsuhiro Isaka, MD, Hajime Kumagai,

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Presentation transcript:

Cold spinoplegia and transvertebral cooling pad reduce spinal cord injury during thoracoabdominal aortic surgery Mitsuhiro Isaka, MD, Hajime Kumagai, MD, Yuji Sugawara, MD, Kenji Okada, MD, Kazumasa Orihashi, MD, Megu Ohtaki, PhD, Taijiro Sueda, PhD Journal of Vascular Surgery Volume 43, Issue 6, Pages 1257-1262 (June 2006) DOI: 10.1016/j.jvs.2006.02.017 Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 1 The pad application in a cross section. Journal of Vascular Surgery 2006 43, 1257-1262DOI: (10.1016/j.jvs.2006.02.017) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 2 Schematic demonstration of this study. The abdominal aorta just distal to the left (Lt) renal artery and just proximal to the iliac bifurcation was cross-clamped by vascular clamps. The cooling pad was placed longitudinally along the vertebral column at the level of L1 to L5 and was attached on the left side surface of these vertebral bodies. Journal of Vascular Surgery 2006 43, 1257-1262DOI: (10.1016/j.jvs.2006.02.017) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 3 Changes in spinal cord temperature at L4. In group I, the spinal cord temperature remained almost unchanged. In groups II and III, the temperature decreased rapidly by 1.8°C ± 0.66°C and 4.3°C ± 0.50°C, respectively, at a minimum. Journal of Vascular Surgery 2006 43, 1257-1262DOI: (10.1016/j.jvs.2006.02.017) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 4 Changes in Tarlov score at each time point. The score was significantly higher for group II than for group I at 8 and 48 hours (P = .007 and P = .02, respectively); however, the score at 24 hours was not significantly different between groups I and II. The score at each time after surgery was significantly different between groups I and III (P < .01). Moreover, the score was significantly higher for group III than for group II at 48 hours (P = .02; Mann-Whitney U test). Journal of Vascular Surgery 2006 43, 1257-1262DOI: (10.1016/j.jvs.2006.02.017) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 5 Typical histopathologic findings of the spinal cord from the rabbit in group I with paraplegia and from the rabbit in group III with normal neurologic function (magnification, ×200). In group I, necrosis in the anterior horn was detected. The cell body was shrunken, and the cytoplasm became eosinophilic, with loss of Nissl granules (▴). In the hypothermia groups, no ischemic damage was detected, and there were many normal motor neurons (arrows). Journal of Vascular Surgery 2006 43, 1257-1262DOI: (10.1016/j.jvs.2006.02.017) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 6 The number of normal neurons was significantly larger in groups II and III than in group I (P < .0001). Moreover, the number of normal neurons was significantly higher in group III than in group II (P = .001; one-way analysis of variance and post hoc test with the Fisher protected least significant difference test). Journal of Vascular Surgery 2006 43, 1257-1262DOI: (10.1016/j.jvs.2006.02.017) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions