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Ann Thorac Surg 2004;78:2213
© 2004 The Society of Thoracic Surgeons

Correspondence

Delayed Paraplegia After Thoracic and Thoracoabdominal Aneurysm Repair: Timing of Reinsertion of Spinal Drain

Ian Hunt, MRCS, Ranjit P. Deshpande, MCh, Christopher Aps, FRCA, Christopher P. Young, FRCS

Cardiothoracic Centre, St. Thomas' Hospital, Lambeth Palace Rd, London SE1 7EH, UK

ian.hunt{at}gstt.nhs.uk

To the Editor:

Much emphasis has been placed on developing perioperative techniques to reduce the insult to the spinal cord at the time of operation. We are very grateful to Maniar and associates [1] for highlighting the particularly distressing complication of delayed paraplegia after thoracoabdominal aneurysm repair. Further, little has been published on the management of delayed paraplegia after aortic vascular surgical procedures.

Among the 60 patients in their study, 5 had the development of delayed postoperative paraplegia or paraparesis between days 3 and 27. All had cerebrospinal fluid drainage intraoperatively, with drainage maintained for 48 to 72 hours postoperatively. In the study, When paraplegia or paraparesis was identified, immediate interventions were undertaken if the neurologic deficit occurred within several days of operation. However, if it occurred more than 1 week after operation, reinsertion of a spinal drain was not thought to be necessary.

Our experience with a patient in whom delayed paraparesis developed demonstrates the usefulness of reinserting a spinal drain, a conclusion different from that of the authors. In our patient, delayed paraparesis (Medical Research Council 2/5) occurred on day 10 after an uneventful operation for a type II thoracoabdominal aneurysm. A spinal drain was placed again, and the neurologic deficit was alleviated entirely (Medical Research Council 5/5). Safi and colleagues [2] described delayed-onset neurologic deficit after thoracoabdominal aortic aneurysm repair in 8 patients at days 1 to 14. These authors concluded that cerebrospinal fluid drainage significantly improved the effects of late-onset neurologic deficit that occurred between 1 day and 2 weeks postoperatively. Several others have reported similar findings.

Most cardiac and vascular surgeons, particularly those in low-volume centers, are likely to have little experience with late-onset neurologic deficit aortic vascular surgical procedures. On the basis of our work and that of others [2], reinsertion of a spinal drain only if neurologic deficit occurs within 1 week after operation is overly restrictive and, with the limited data currently available, has little evidence to support it.

References

  1. Maniar HS, Sundt TM III, Prasad SM, et al. Delayed paraplegia after thoracic and thoracoabdominal aneurysm repair: a continuing risk. Ann Thorac Surg. 2003;75:113–120[Abstract/Free Full Text]
  2. Safi HJ, Miller CC III, Azizzadeh A, Iliopoulos DC. Observations on delayed neurologic deficit after thoracoabdominal aortic aneurysm repair. J Vasc Surg. 1997;26:616–622[Medline]




This Article
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Ranjit P. Deshpande
Christopher P. Young
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