{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,20]],"date-time":"2025-07-20T03:42:43Z","timestamp":1752982963207},"reference-count":3,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>To avoid spinal cord ischemia following endovascular\/open thoracic-abdominal aortic aneurysm (T-AAA) repair, lumbar drains (LDs) are placed to reduce intraspinal pressure, and increase spinal perfusion pressure. Here, we present a medicolegal case in which a critical care (CC) physician knew that the LD was obstructed following a T-AAA repair, but did not replace it until the patient became paraplegic. The patient was left with permanent sphincter loss, and a severe paraparesis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Methods: <\/jats:title>\n<jats:p>A geriatric patient with multiple medical\/cardiovascular comorbidities first underwent an endovascular T-AAA (Crawford Type II T-AAA) repair several years ago. Due to continued expansion of the aneurysm, the patient now required an open T-AAA repair.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Results: <\/jats:title>\n<jats:p>Prior to the open T-AAA surgery, a prophylactic LD was placed. Postoperatively, the patient required a second emergency operation to repair a leaking intercostal artery anastomosis. The next morning, the CC physician clearly documented the drain was obstructed, but chose to follow the patient; 3.5 hours later, the patient became paraplegic. The LD was replaced after the patient was first sent to MRI to rule out a spinal cord hematoma, resulting in a total delay of more than 6.5 h from when the CC physician first became aware of the non-functioning LD. The patient later regained only partial function, remaining significantly paraparetic with total loss of bowel\/bladder function.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st4\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>LD for endovascular\/open T-AAA repairs reduce spinal fluid pressure, increase spinal cord perfusion pressures, and limits the frequency (i.e. 2.3\u20132.6%) of resultant spinal cord ischemia\/paralysis. Here, despite the CC physician\u2019s failure to replace an obstructed LD after an open T-AAA, repair, the jury rendered a defense verdict.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_191_2021","type":"journal-article","created":{"date-parts":[[2022,1,26]],"date-time":"2022-01-26T07:53:28Z","timestamp":1643183608000},"page":"207","update-policy":"http:\/\/dx.doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["MEDICOLEGAL CORNER. Failure to replace obstructed lumbar drain after thoracic-abdominal aortic aneurysm repair leads to paraplegia"],"prefix":"10.25259","volume":"12","author":[{"given":"Nancy E.","family":"Epstein","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2021,5,3]]},"reference":[{"key":"10.25259\/SNI_191_2021\/ref-1","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1067\/mva.2002.122024","article-title":"Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair: Results of a randomized clinical trial","volume":"35","author":"Coselli","year":"2002","journal-title":"J Vasc Surg"},{"key":"10.25259\/SNI_191_2021\/ref-2","doi-asserted-by":"crossref","first-page":"48","DOI":"10.4103\/sni.sni_433_17","article-title":"Cerebrospinal fluid drains reduce risk of spinal cord injury for thoracic\/thoracoabdominal aneurysm surgery: A review","volume":"9","author":"Epstein","year":"2018","journal-title":"Surg Neurol Int"},{"key":"10.25259\/SNI_191_2021\/ref-3","doi-asserted-by":"crossref","first-page":"383","DOI":"10.3171\/2016.1.SPINE151199","article-title":"The use of lumbar drains in preventing spinal cord injury following thoracoabdominal aortic aneurysm repair: An updated systematic review and meta-analysis","volume":"25","author":"Khan","year":"2016","journal-title":"J Neurosurg Spine"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/medicolegal-corner-failure-to-replace-obstructed-lumbar-drain-after-thoracic-abdominal-aortic-aneurysm-repair-leads-to-paraplegia","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/medicolegal-corner-failure-to-replace-obstructed-lumbar-drain-after-thoracic-abdominal-aortic-aneurysm-repair-leads-to-paraplegia","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,26]],"date-time":"2022-01-26T07:53:32Z","timestamp":1643183612000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/medicolegal-corner-failure-to-replace-obstructed-lumbar-drain-after-thoracic-abdominal-aortic-aneurysm-repair-leads-to-paraplegia"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,3]]},"references-count":3,"alternative-id":["10.25259\/SNI_191_2021"],"URL":"https:\/\/doi.org\/10.25259\/sni_191_2021","relation":{},"ISSN":["2152-7806"],"issn-type":[{"value":"2152-7806","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,3]]},"article-number":"207"}}