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Investigating non-invasive techniques to detect spinal cord ischemia

Lovkesh Arora, MBBS, MD, is conducting research to see if non-invasive Near Infrared Spectroscopy (NIRS) can alert anesthesiologists to possible spinal cord ischemia (SCI) during a procedure.
SCI remains a major concern during open and endovascular repair of descending thoracic aneurysms and thoracoabdominal aortic aneurysms (TAAAs). It occurs in 8-10 percent of patients and can result in partial or total paralysis that may last hours, days, weeks, or months. Although the etiology of SCI is multifactorial, coverage of large aortic segments, insufficient collaterals, arterial embolization, and systemic hypotension are the main predisposing factors during endovascular TAAAs.

“When a patient gets spinal cord ischemia, our answers are still very vague,” Arora says. “When a family asks how much the patient is going to improve, we don’t know. When they ask how much time it will take to pass off, we don’t know. So I strongly believe the best approach is to prevent this complication, to not let it happen.”
One possible way to prevent spinal cord ischemia is to insert a lumbar drain before the procedure to reduce the pressure around the spinal cord. Another method is neuro monitoring, specifically SSEP (SomatoSensory Evoked Potential Monitoring) and MEP (Motor Evoked Potential Monitoring), which can be done during the procedure to immediately recognize SCI and may allow the use of maneuvers to optimize spinal cord perfusion. However, SSEP and MEP are invasive, and their accuracy can be affected by anesthetic agents. Arora is investigating whether he can get the same information from non-invasive NIRS patches.
Learn more about this research by watching the video:

Monday, February 1, 2021