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Ann Thorac Surg 1994;58:116-120
© 1994 The Society of Thoracic Surgeons

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Articles

Spinal cord protection: Development of a paraplegia-preventive solution

Division of Thoracic Surgery, Department of Surgery, Saga Medical School, Saga, Japan

Accepted for publication November 4, 1993.

^_* Address reprint requests to Dr Ueno, Division of Thoracic Surgery, Department of Surgery, Saga Medical School, 5-1-1 Nabeshima, Saga City, Saga 849, Japan.

We present a clinically available method to protect the spinal cord against ischemic or reperfusion injury and to prevent paraplegia after cross-clamping of the aorta. We separated 35 rabbits into five equal groups and clamped each animal's abdominal aorta distal to the left renal artery. We also occluded the aortas 2 cm above the iliac bifurcation for 45 minutes with inflated 5F balloon catheters. Through the catheter port distal to each balloon one of four different solutions was infused at 3 °C for 3 minutes at a rate of 5 µL/min (group I, uninfused control; group II, lactated Ringer's solution; group III, iactated Ringer's solution + 30 mg/kg of methylprednisolone; group IV, lactated Ringer's solution + methylprednisolone + 3 mL of 20% mannitol; group V, lactated Ringer's solution + methylprednisolone + mannitol + 10 mg/kg of vitamins E and C). We assessed the neurologic status of the hind limbs on the second postoperative day using Tarloy's criteria. The neurologic status in groups III, IV, and V was significantly superior to that of group I (p < 0.05, groups III versus I; p < 0.01, groups IV and V versus I). Spastic paraplegia occurred in 71% of group I, in 43% of group II, in 29% of group III, in 14% of group IV, and not at all in group V. The infusion of our specially blended solution with several spinal cord neuroprotective properties (hypothermia, methylprednisolone, mannitol, and vitamins E and C) achieved the best spinal cord protection against ischemic or reperfusion injury and prevented postoperative paraplegia.

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