The Role of Cerebrospinal Fluid S100 and Lactate to Predict Clinically Evident Spinal Cord Ischaemia in Thoraco-abdominal Aortic Surgery

ObjectiveDetecting spinal cord ischemia early during replacement of the thoracoabdominal aorta remains a challenge. In a high risk population, we have re-evaluated the potential impact of ischaemia/damage markers (S100, lactate) in the peripheral blood and CSF for perioperative patient management.Patients and methodsThirteen patients undergoing replacement of the thoracoabdominal aorta (6 female, age 63 (27–71)) with continuous CSF pressure monitoring and drainage were entered into the study. A total of 485 CSF (C) and serum (S) samples were collected and analysed for S100, lactate and glucose.ResultsTwo patients suffered from spinal cord injury (SCI) (15%). During and early after surgery, there was a strong correlation between C-S100 levels (r = 0.79) and C-lactate levels (r = 0.77) with time in patients with SCI. In patients with SCI C-lactate levels increased soon after aortic cross-clamping, whereas C-S100 levels did not become significantly elevated until 6 hours after cross-clamping.ConclusionAn increase of C-lactate occurs much earlier than the increase in C-S100 in patients with SCI. Both parameters may be used to adjust protective and therapeutic measures intra- and postoperatively.