OBJECTIVE The aim of this study was to assess myelomeningocele mortality, correlate these findings to lesion level, and investigate mortality evolution. METHODS From the population-based western Denmark myelomeningocele database, the authors extracted the records of 187 patients born between January 1, 1970, and July 1, 2015. Patients were categorized according to their most rostral lesion level into cervical, thoracic, lumbar, or sacral groups. Furthermore, patients were categorized based on their birth dates (1970–1979, 1980–1989, and 1990–2015). Mortality data was extrapolated from the university hospital's electronic charts, which are based on the Danish Civil Registration System, and compared according to mortality, lesion level, and date of birth. Data were also extracted from nationwide Danish registers. Additionally, the authors divided the patients according to date of birth before or after the advent of prenatal detection (2004), and compared mortality rates of these two groups. RESULTS A thoracic lesion level was associated with a significantly higher mortality rate (p = 0.01). Two patients had a cervical lesion and were alive at the end of follow-up. The mortality rate decreased over time, although not significantly for the subsequent time periods. Prenatal detection did not affect mortality. CONCLUSIONS The presented data suggest increased mortality with ascending lesion level in patients with myelomeningocele, except for patients with cervical lesions. The mortality rate improved over time, suggesting that modern treatment modalities improve survival in patients with myelomeningocele.

Study design: Cross-sectional study. Objective: To evaluate the long-term effect of the sacral anterior root stimulator (SARS) on neurogenic bowel dysfunction in a large, well defined spinal cord injury (SCI) cohort. Setting: Department of Neuro-Urology, Bad Wildungen, Germany. Methods: Subjects undergone surgery at for SARS-SDAF (sacral deafferentation) between September 1986 and July 2011 (n = 587) answered a questionnaire. In total, 277 SARS subjects were available for the baseline (recall) and follow-up comparison. Results: Median age was 49 years (range: 19-80), time from SCI to surgery was 10 years (range: 0-49) and from surgery to follow-up 13 (range: 1-25). Of the responders 73% used SARS for bowel emptying. On visual analog scale (VAS) ranging from 0-10 (best), satisfaction with SARS was 10. Baseline and follow-up comparison showed a decline in the median VAS score 0-10 (worst) for bowel symptoms from 6 (range: 4-8) to 4 (range: 2-6), Po0.0001; median neurogenic bowel dysfunction score from 17 (range: 11-2) to 11 (range: 9-15), Po0.0001; median St Marks score from 4 (range: 0-7) to 4 (range: 0-5), P = 0.01; and median Cleveland constipation score from 7 (range: 6-10) to 6 (range: 4-8), Po0.0001. Use of suppositories, digital evacuation and mini enema and subjects totally dependent on assistance during defecation were significantly lower after SARS. Conclusions: The SARS has the potential to be one of the few treatment methods targeting multiple organ dysfunctions following SCI.

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In contrast to earlier findings, creation of an artificial somato-autonomic reflex arch in patients with spinal cord injury had no clinically relevant effect on lower urinary tract function.

Background. Loss of normal bowel function caused by nerve injury, neurological disease or congenital defects of the nervous system is termed neurogenic bowel dysfunction (NBD). It usually includes combinations of fecal incontinence, constipation, abdominal pain and bloating. When standard treatment of NBD fails surgical procedures are often needed. Neurostimulation has also been investigated, but no consensus exists about efficacy or clinical use. Methods. A systematic literature search of NBD treated by sacral anterior root stimulation (SARS), sacral nerve stimulation (SNS), peripheral nerve stimulation, magnetic stimulation, and nerve re-routing was made in Pubmed, Embase, Scopus, and the Cochrane Library. Results. SARS improves bowel function in some patients with complete spinal cord injury (SCI). Nerve re-routing is claimed to facilitate defecation through mechanical stimulation of dermatomes in patients with complete or incomplete SCI or myelomeningocele. SNS can reduce NBD in selected patients with a variety of incomplete neurological lesions. Peripheral stimulation using electrical stimulation or magnetic stimulation may represent non-invasive alternatives. Conclusion. Numerous methods of neurostimulation to treat NBD have been investigated in pilot studies or retrospective studies. Therefore, larger controlled trials with well-defined inclusion criteria and endpoints are recommended before widespread clinical use of neurostimulation against NBD.