The use of lumbar drains in preventing Spinal cord injury following thoracoabdominal aortic aneurysm repair

An updated systematic review and meta-analysis

Nickalus R. Khan, Zachary Smalley, Cody L. Nesvick, Siang Liao Lee, Lattimore Michael

Research output: Contribution to journalReview article

19 Citations (Scopus)

Abstract

OBJECTIVE: Paraplegia and paraparesis following aortic aneurysm repair occur at a substantially high rate and are often catastrophic to patients, their families, and the overall health care system. Spinal cord injury (SCI) following open thoracoabdominal aortic aneurysm (TAAA) repair is reported to be as high as 20% in historical controls. The goal of this study was to determine the impact of CSF drainage (CSFD) on SCI following TAAA repair. METHODS: In August 2015 a systematic literature search was performed using clinicaltrials.gov, the Cochrane Library, PubMed/MEDLINE, and Scopus that identified 3478 articles. Of these articles, 10 met inclusion criteria. Random and fixed-effect meta-analyses were performed using both pooled and subset analyses based on study type. RESULTS: The meta-analysis demonstrated that CSFD decreased SCI by nearly half (relative risk 0.42, 95% confidence interval 0.25-0.70; p = 0.0009) in the pooled analysis. This effect remained in the subgroup analysis of early SCI but did not remain significant in late SCI. CONCLUSIONS: This meta-analysis showed that CSFD could be an effective strategy in preventing SCI following aortic aneurysm repair. Care should be taken to prevent complications related to overdrainage. No firm conclusions can be drawn about the newer endovascular procedures at the current time.

Original languageEnglish (US)
Pages (from-to)383-393
Number of pages11
JournalJournal of Neurosurgery: Spine
Volume25
Issue number3
DOIs
StatePublished - Sep 1 2016

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Thoracic Aortic Aneurysm
Spinal Cord Injuries
Meta-Analysis
Drainage
Aortic Aneurysm
Paraparesis
Endovascular Procedures
Family Health
Paraplegia
PubMed
MEDLINE
Libraries
Confidence Intervals
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

The use of lumbar drains in preventing Spinal cord injury following thoracoabdominal aortic aneurysm repair : An updated systematic review and meta-analysis. / Khan, Nickalus R.; Smalley, Zachary; Nesvick, Cody L.; Lee, Siang Liao; Michael, Lattimore.

In: Journal of Neurosurgery: Spine, Vol. 25, No. 3, 01.09.2016, p. 383-393.

Research output: Contribution to journalReview article

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abstract = "OBJECTIVE: Paraplegia and paraparesis following aortic aneurysm repair occur at a substantially high rate and are often catastrophic to patients, their families, and the overall health care system. Spinal cord injury (SCI) following open thoracoabdominal aortic aneurysm (TAAA) repair is reported to be as high as 20{\%} in historical controls. The goal of this study was to determine the impact of CSF drainage (CSFD) on SCI following TAAA repair. METHODS: In August 2015 a systematic literature search was performed using clinicaltrials.gov, the Cochrane Library, PubMed/MEDLINE, and Scopus that identified 3478 articles. Of these articles, 10 met inclusion criteria. Random and fixed-effect meta-analyses were performed using both pooled and subset analyses based on study type. RESULTS: The meta-analysis demonstrated that CSFD decreased SCI by nearly half (relative risk 0.42, 95{\%} confidence interval 0.25-0.70; p = 0.0009) in the pooled analysis. This effect remained in the subgroup analysis of early SCI but did not remain significant in late SCI. CONCLUSIONS: This meta-analysis showed that CSFD could be an effective strategy in preventing SCI following aortic aneurysm repair. Care should be taken to prevent complications related to overdrainage. No firm conclusions can be drawn about the newer endovascular procedures at the current time.",
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N2 - OBJECTIVE: Paraplegia and paraparesis following aortic aneurysm repair occur at a substantially high rate and are often catastrophic to patients, their families, and the overall health care system. Spinal cord injury (SCI) following open thoracoabdominal aortic aneurysm (TAAA) repair is reported to be as high as 20% in historical controls. The goal of this study was to determine the impact of CSF drainage (CSFD) on SCI following TAAA repair. METHODS: In August 2015 a systematic literature search was performed using clinicaltrials.gov, the Cochrane Library, PubMed/MEDLINE, and Scopus that identified 3478 articles. Of these articles, 10 met inclusion criteria. Random and fixed-effect meta-analyses were performed using both pooled and subset analyses based on study type. RESULTS: The meta-analysis demonstrated that CSFD decreased SCI by nearly half (relative risk 0.42, 95% confidence interval 0.25-0.70; p = 0.0009) in the pooled analysis. This effect remained in the subgroup analysis of early SCI but did not remain significant in late SCI. CONCLUSIONS: This meta-analysis showed that CSFD could be an effective strategy in preventing SCI following aortic aneurysm repair. Care should be taken to prevent complications related to overdrainage. No firm conclusions can be drawn about the newer endovascular procedures at the current time.

AB - OBJECTIVE: Paraplegia and paraparesis following aortic aneurysm repair occur at a substantially high rate and are often catastrophic to patients, their families, and the overall health care system. Spinal cord injury (SCI) following open thoracoabdominal aortic aneurysm (TAAA) repair is reported to be as high as 20% in historical controls. The goal of this study was to determine the impact of CSF drainage (CSFD) on SCI following TAAA repair. METHODS: In August 2015 a systematic literature search was performed using clinicaltrials.gov, the Cochrane Library, PubMed/MEDLINE, and Scopus that identified 3478 articles. Of these articles, 10 met inclusion criteria. Random and fixed-effect meta-analyses were performed using both pooled and subset analyses based on study type. RESULTS: The meta-analysis demonstrated that CSFD decreased SCI by nearly half (relative risk 0.42, 95% confidence interval 0.25-0.70; p = 0.0009) in the pooled analysis. This effect remained in the subgroup analysis of early SCI but did not remain significant in late SCI. CONCLUSIONS: This meta-analysis showed that CSFD could be an effective strategy in preventing SCI following aortic aneurysm repair. Care should be taken to prevent complications related to overdrainage. No firm conclusions can be drawn about the newer endovascular procedures at the current time.

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