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Protecting the spinal cord during thoracic endovascular aortic repair—who should place the spinal drain?
A well-placed and functioning lumbar spinal drain, for spinal cord protection, is an important aspect of the perioperative care of patients undergoing thoracic endovascular aortic repair (TEVAR) procedures. Spinal cord injury (SCI) is a devastating complication of TEVAR procedures and is most often...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10331502/ https://www.ncbi.nlm.nih.gov/pubmed/37435327 http://dx.doi.org/10.21037/jss-22-116 |
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author | Foley, Edward D. Kumar, Vikas |
author_facet | Foley, Edward D. Kumar, Vikas |
author_sort | Foley, Edward D. |
collection | PubMed |
description | A well-placed and functioning lumbar spinal drain, for spinal cord protection, is an important aspect of the perioperative care of patients undergoing thoracic endovascular aortic repair (TEVAR) procedures. Spinal cord injury (SCI) is a devastating complication of TEVAR procedures and is most often associated with Crawford type 2 repairs. Current evidence-based guidelines for the surgical management of patients with thoracic aortic disease include the role of lumbar spine catheter placement and drainage of cerebrospinal fluid (CSF) intraoperatively as part of a strategy to prevent spinal cord ischemia. More often than not, the procedure of lumbar spinal drain placement, using a standard blind technique, and subsequent drain management is the responsibility of the anesthesiologist. However, institutional protocols are inconsistent, and, failure to successfully place the lumbar spinal drain pre-operatively in the operating room, in clinical situations such as patients with poor anatomical landmarks or prior back surgery, presents a clinical dilemma and impacts spinal cord protection during TEVAR. Although a relatively safe procedure, potential complications of lumbar spine catheter placement range from a self-limiting headache to hemorrhage and permanent neurological injury. Spinal drain placement with image-guided fluoroscopy by interventional radiology should be considered in the preoperative assessment and planning and is an alternative to conventional, blind lumbar drain insertion. |
format | Online Article Text |
id | pubmed-10331502 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-103315022023-07-11 Protecting the spinal cord during thoracic endovascular aortic repair—who should place the spinal drain? Foley, Edward D. Kumar, Vikas J Spine Surg Mini-Review A well-placed and functioning lumbar spinal drain, for spinal cord protection, is an important aspect of the perioperative care of patients undergoing thoracic endovascular aortic repair (TEVAR) procedures. Spinal cord injury (SCI) is a devastating complication of TEVAR procedures and is most often associated with Crawford type 2 repairs. Current evidence-based guidelines for the surgical management of patients with thoracic aortic disease include the role of lumbar spine catheter placement and drainage of cerebrospinal fluid (CSF) intraoperatively as part of a strategy to prevent spinal cord ischemia. More often than not, the procedure of lumbar spinal drain placement, using a standard blind technique, and subsequent drain management is the responsibility of the anesthesiologist. However, institutional protocols are inconsistent, and, failure to successfully place the lumbar spinal drain pre-operatively in the operating room, in clinical situations such as patients with poor anatomical landmarks or prior back surgery, presents a clinical dilemma and impacts spinal cord protection during TEVAR. Although a relatively safe procedure, potential complications of lumbar spine catheter placement range from a self-limiting headache to hemorrhage and permanent neurological injury. Spinal drain placement with image-guided fluoroscopy by interventional radiology should be considered in the preoperative assessment and planning and is an alternative to conventional, blind lumbar drain insertion. AME Publishing Company 2023-05-30 2023-06-30 /pmc/articles/PMC10331502/ /pubmed/37435327 http://dx.doi.org/10.21037/jss-22-116 Text en 2023 Journal of Spine Surgery. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Mini-Review Foley, Edward D. Kumar, Vikas Protecting the spinal cord during thoracic endovascular aortic repair—who should place the spinal drain? |
title | Protecting the spinal cord during thoracic endovascular aortic repair—who should place the spinal drain? |
title_full | Protecting the spinal cord during thoracic endovascular aortic repair—who should place the spinal drain? |
title_fullStr | Protecting the spinal cord during thoracic endovascular aortic repair—who should place the spinal drain? |
title_full_unstemmed | Protecting the spinal cord during thoracic endovascular aortic repair—who should place the spinal drain? |
title_short | Protecting the spinal cord during thoracic endovascular aortic repair—who should place the spinal drain? |
title_sort | protecting the spinal cord during thoracic endovascular aortic repair—who should place the spinal drain? |
topic | Mini-Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10331502/ https://www.ncbi.nlm.nih.gov/pubmed/37435327 http://dx.doi.org/10.21037/jss-22-116 |
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