New and future approaches for spinal cord protection.

The major cause of spinal cord injury, during and after aortic surgery, is based on the occurrence of one or more of the three following events: (1) the duration and degree of ischemia;(2) failure to re-establish blood flow to the spinal cord after the repair; and (3) a biochemically mediated reperfusion injury. Clinically, this manifests either as permanent or reversible paraplegia or paraparesis, or a neurogenic bladder. For more than 40 years, numerous methods have been attempted to prevent paralysis, and some of the newer technical innovations include reducing the duration of ischemia, the use of newer centrifugal pump distal perfusion techniques, localized hypothermia, intrathecal maneuvers, pharmacological agents, angiography, somatosensory-evoked potential monitoring, spinal motor-evoked potential monitoring, hydrogen mapping, not resecting the posterior aortic wall, the use of stents, and a spectrum of various pharmacological agents to prevent reperfusion injury to the spinal cord. Some of these techniques and agent seem to be effective at reducing the risk of spinal cord injury.