Spinal Cord Protection for Thoracic Aortic Surgery: Bench to Bedside

This article summarizes the anatomically driven pathophysiology of spinal cord injury, the impact of ischemia reperfusion on the cellular level, current research in developing neuronal ischemic tolerance, and promotion of collateralization. It addresses neuroprotective strategies in modern clinical practice, current pharmacologic interventions, and continued challenges in the management of complex aortic disease. The pathophysiology of spinal cord injury includes disruption and recovery of collateral blood flow and the effects of malperfusion on the spinal cord. The optimal approach to spinal cord protection is to employ an integrated and protocolized set of strategies to simultaneously maximize spinal cord blood flow, improve ischemic tolerance, and promote collateralization. In the laboratory setting, investigation should continue to pursue a more granular understanding of ischemic injury and seek to translate protective therapies to clinical practice.