Lumbar CSF Drainage for Spinal Cord Protection

As disease awareness and diagnostic modalities continue to improve, the prevalence of thoracic aortic disease (aneurysm and dissection) is increasing, affecting up to 16.3 individuals per 100,000 per year. 1,2 However lifesaving surgery may be, paraplegia remains one of the most devastating complications of thoracoabdominal aortic surgery and is associated with a significant increase in both morbidity and mortality. 3-5 Historically, an incidence as high as 40% for this complication has been reported, 5-8 though more recent reports indicate an incidence of less than 20%. 3,9,10 Modern aortic repair techniques employ many modalities aimed at reducing the risk of spinal cord ischemia inherent with surgical management. One of these modalities acting via optimizing spinal cord blood flow is drainage of lumbar cerebrospinal fluid (CSF). Either alone or in combination with other interventions, CSF drainage remains one of the most frequently used spinal cord protection techniques. Despite no definitive proof of efficacy for reducing spinal cord injury, there is compelling data supporting its use. However, the potential benefit of CSF drainage must be balanced against the risks associated with its use, including nerve injury during insertion, compressive neuraxial hematoma formation, intracranial hemorrhage due to excessive drainage, and infection.