ABSTRACT
STUDY DESIGN: This is a retrospective review of clinical records for evidence of paraplegia specifically resulting from segmental vessel ligation during anterior spinal surgery. OBJECTIVES: To determine the precise risk rate, and to potentially identify risk factors. SUMMARY OF BACKGROUND DATA: Although many authors have alluded to this risk, the exact risk rate and risk factors have never been identified. METHODS: All patients having an anterior approach involving T1-L3 were reviewed. The two reviewers were not involved in any of the surgeries. The 1197 cases were consecutive from 1967 to 1991. RESULTS: There were no paralyses. CONCLUSIONS: There would appear to be virtually no risk to segmental vessel ligation provided: 1) vessel ligation is unilateral, 2) done on the convexity of a scoliosis, 3) ligated at midvertebral body level, and 4) hypotensive anesthesia is avoided. Soft clamping with somatosensory-evoked potential monitoring does not appear justified.
Subject(s)
Paraplegia/etiology , Spine/blood supply , Spine/surgery , Adult , Child , Humans , Ligation , Lumbar Vertebrae/surgery , Retrospective Studies , Risk Factors , Spinal Fusion/adverse effects , Spinal Fusion/methods , Thoracic Vertebrae/surgery , Thoracotomy , Vascular Surgical Procedures/adverse effectsABSTRACT
A retrograde aortic dissection that occurred during cardiopulmonary bypass was successfully repaired. The cause of dissection was related to the jet of retrograde perfusion. The use of subclavian-to-coronary artery vein bypass when the ascending aorta is not suitable for vein anastomosis because of dissection or aneurysms appears to be a satisfactory alternative to aorta-coronary bypass.
