{"doi":"10.1016/j.xjon.2020.08.019","title":"Commentary: “Spinoplegia”: A new solution for ischemic spinal cord injury?","abstract":"Central MessageThe creation of nanobubble technology for spinal cord protection is promising in rabbit models and, if proven to be safe and efficacious in humans, will become the standard of care just as CSF drains.See Article page 1 in the September 2020 issue.The history of spinal cord ischemic injury secondary to aortic aneurysm repair dates back to Dr Alexis Carrel's prediction of the complication in 1910. Evidence from the Society of Thoracic Surgeons and Vascular Quality Initiative registry show that this feared complication is still prevalent today. Currently, the only interventions used to prevent or treat this complication are hypothermia, cerebrospinal fluid (CSF) drains, and systemic and spinal cord perfusion pressure management.Naganuma and colleagues1Naganuma M. Saiki Y. Kanda K. Akiyama M. Adachi O. Horii A. et al.Nanobubble technology to treat spinal cord ischemic injury.J Thorac Cardiovasc Surg Open. 2020; 3: 1-11Scopus (4) Google Scholar advent of using nanobubble technology as an adjunct to prevent spinal cord ischemia following crossclamping during aortic aneurysm repair procedures shows promise. Nanobubbles provide an alternative pathway to supply oxygen to the spinal cord that suppresses the inflammatory responses secondary to ischemia–reperfusion injury following aortic crossclamping. The question is will this promising technology be transferable from animal models to humans, and what are the potential limitations to this transferability? Naganuma colleagues1Naganuma M. Saiki Y. Kanda K. Akiyama M. Adachi O. Horii A. et al.Nanobubble technology to treat spinal cord ischemic injury.J Thorac Cardiovasc Surg Open. 2020; 3: 1-11Scopus (4) Google Scholar suggest potential limitations in their study, but there are more to consider with regard to transferability to humans.One major limitation in the transferability from the animal models of this study to humans is the difference in spinal cord vascular anatomy between small animal models and humans. This differing anatomy may limit the diffusion of nanoparticles deep into the gray matter where interneurons are located, and where our research shows ischemic damage begins.2Awad H. Ankeny D.P. Guan Z. Wei P. McTigue D.M. Popovich P.G. A mouse model of ischemic spinal cord injury with delayed paralysis caused by aortic cross-clamping.Anesthesiology. 2010; 113: 880-891Crossref PubMed Scopus (37) Google Scholar In addition, the intrathecal space is a closed space and the injection of artificial, oxygenated CSF at a rate of 5 mL/h of in rabbit models performed in this study would be equivalent to an injection of 350 mL/h in humans. Our preclinical and clinical work has documented spinal cord edema as part of the mechanism of spinal cord ischemic injury.3Awad H. Bratasz A. Nuovo G. Burry R. Meng X. Kelani H. et al.MiR-155 deletion reduces ischemia-induced paralysis in an aortic aneurysm repair mouse model: utility of immunohistochemistry and histopathology in understanding etiology of spinal cord paralysis.Ann Diagn Pathol. 2018; 36: 12-20Crossref Scopus (20) Google Scholar It is not clear what the impact of large volumes of fluid injection will be on spinal cord edema in humans. Finally, we believe that the mechanism of ischemic spinal cord injury between open and endovascular repair of aortic aneurysms is different. The mechanism of spinal cord damage in open repair is ischemia–reperfusion versus critical permanent hypoperfusion in endovascular repair. In addition, we believe that the location of spinal cord damage in endovascular repair is predominantly located in the white matter, which is consistent with a different mechanism of injury following this surgical technique.4Awad H. Ramadan M.E. El Sayed H.F. Tolpin D.A. Tili E. Collard C.D. Spinal cord injury after thoracic endovascular aortic aneurysm repair.Can J Anaesth. 2017; 64: 1218-1235Crossref PubMed Scopus (48) Google Scholar Therefore, we do not know what the impact of nanobubbles will be on spinal cord damag","journal":"JTCVS Open","year":2020,"id":131153,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9633,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":336272,"name":"Bryan A. Whitson","orcid":"0000-0003-0040-3638","position":1,"is_corresponding":false},{"id":542520,"name":"Hamdy Awad","orcid":"0000-0003-0715-4347","position":0,"is_corresponding":true}],"reference_count":7,"raw_metadata":null,"created_at":"2026-07-18T23:16:00.235845Z","pmid":"36003185","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}