Rehabilitation for Spinal Cord Injury Caused by Thoracic Aortic Aneurysm

Aortic aneurysm (AA) is a life threatening condition. Large AA carries a substantial risk of rupture. Observational studies have reported a 14.1% annual incidence rate of aortic rupture. Once the aorta has reached a diameter of 6 cm the risk of rupture increases in proportion to the aortic diameter (Elefteriades, 2002). The 5-year cumulative risk of rupture has been estimated to be 31 % among aneurysms wider than 6 cm (Clouse et al., 1998). A ruptured thoracic aortic aneurysm (TAA) is a medical catastrophe, and the survival rate is extremely low (Johansson et al., 1995). The incidence of thoracoabdominal aortic aneurysm (TAAA) was estimated to be 16.3 per 100,000 males and 9.1 per 100,000 females in a recent review of the Swedish National Healthcare Register, which reported increasing incidences over a 15-year period (Olsson et al., 2006). The incidence of thoracic aortic aneurysms in Rochester, Minnesota, was 5.9 per 100,000 (Bickerstaff et al., 1982). The Swedish register study also found that the frequency of thoracoabdominal aortic surgery had increased from 7 to 15 fold during the study period. A series of 1004 patients who underwent thoracoabdominal aortic operations were reported to have a 5-year mortality of 39% compared with a matched population of untreated patients with a 5-year mortality of 87% (Miller III et al., 2004). However, aneurysm surgery also carries a risk of death (Rectenwald et al., 2002): mortality at 30 days ranges from 4.8%-8.3% (Coselli et al., 2000; Etz et al., 2006; Greenberg et al., 2008; Svensson et al., 1993). Moreover, the complications associated with this type of surgery are devastating and unpredictable, e.g., thoracic spinal cord infarction (Crawford et al., 1970; Grace & Mattox, 1977; Sliwa & Maclean, 1992) and renal failure caused by renal artery occlusion (Coselli & Le Maire, 1999; Svensson et al., 1991; 1993), which can induce a sedentary state. Aortic aneurysm is a degenerative condition, which means that the patients with this condition are usually elderly, except for those with Marfan syndrome (Etz et al., 2006). Elderly patients are susceptible to respiratory system complications. In long operations, such as open thoracotomy, paraplegia and recurrent laryngeal nerve (RLN) palsy can also occur (discussed later), leading to respiratory system failure. Spinal cord injury (SCI) rehabilitation is hard and requires a long period of exercise. Severely impaired patients with SCI and/or respiratory failure and/or renal failure are often elderly; therefore, it is very hard for them to undergo rehabilitation. These above issues are discussed in this chapter together with our experiences.