Controversy for Cardiac Anesthesia
Spinal Protection : Current Drug Therapy and Its Future

Abstract

  How to anticipate paraplegia due to spinal ischemia during aortic replacement for thoracoabdominal aortic aneurysm (TAAA) is a critical problem. Paraplegia itself disturbs the quality of life (QOL) of the patients and restricts their daily life activities. Paraplegia sometimes occurs after TAAA and it is determined by spinal ischemia during surgery, and reduction of blood supply to the Adamkiewicz artery plays a key role in spinal ischemia leading to paraplegia. Once spinal ischemia is induced, both white and gray matter are injured. In particular, spinal motor neurons lead to delayed neuronal death and a putative mechanism is based on the glutamate-Ca²⁺ theory, glial activation and mitochondrial dysfunction. Efficacious drug therapy to prevent spinal injury is not established, however, drug therapy that modulates mitochondrial dysfunction might be the key to opening new avenues.