ISCHEMIC MYELOPATHY FOLLOWING AORTIC-SURGERY OR TRAUMATIC LACERATION OF THE AORTA

Paraplegia is one of the major complications following repair of aorti c aneurysms or congenital malformations and from trauma of the aorta. In a series of 12 surviving patients we describe the clinical features as well as the evolution and pathophysiology of ischaemic lesions of the spinal cord, The clinical characteristics: loss of tendon reflexes , preservation of light touch sensation and bladder function, and the special topography of pin prick impairment, suggest involvement of the central grey matter, This lesion of the grey matter is incomplete in most of the patients and tends to extend for 2-10 segments. In some ca ses it can extend downward to the conus resulting in complete flaccid paraplegia. On follow-up we have observed limited improvement in most cases. No patient has recovered fully. Except in cases of traumatic la ceration, where symptoms existed before surgery, paraplegia followed s urgical repair in all other cases. Ischaemia can be related to the dur ation and the site of crossclamping of the aorta. Clamping above the l eft subclavian artery and/or a ligation of the intercostal arteries wi thout previous visualisation of the spinal cord arteries can be danger ous. Other factors such as the phenomena of revascularisation and the presence of free radicals are discussed. These could explain delayed p ostischaemic spinal cord hypoperfusion.