Control of defecation in patients with spinal injuries by stimulation of sacral anterior nerve roots.

MacDonagh, Riodrach; Sun, Weiming; Smallwood, R. H.; Förster, David; Read, N W

doi:10.1136/bmj.300.6738.1494

Cited by 115 publications

(52 citation statements)

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“…Nine studies (aggregate N ¼ 137) evaluated the effects of surgical implantation of electrical stimulation systems (Table 10). [51][52][53][54][55][56][57][58][59] There is Level 2 evidence (from one prospective, non-randomizedcontrolled trial) 51 that supports the use of sacral anterior root stimulation to reduce severe constipation in complete injuries. Binnie et al 51 had found that an implanted Brindley stimulator did not reduce oro-cecal time for individuals with Figure 2 Schematic diagram of the enema continence catheter.…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, recent pre-post studies using sacral nerve root stimulation yielded improvements in bowel function, including the ability to evacuate spontaneously, 52 reduced bowel program times, 53,59 elimination of autonomic dysreflexia related to bowel management 53 increased quality of life, 53,57 elimination of manual help for defecation, 54 and reduced number of incontinence episodes. 57,58 Conflicting evidence exists, however, on the effects of resting and squeeze canal pressures.…”

Section: Resultsmentioning

confidence: 99%

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Neurogenic bowel management after spinal cord injury: a systematic review of the evidence

et al. 2010

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Study design: Randomized-controlled trials (RCTs), prospective cohort, case-control, pre-post studies, and case reports that assessed pharmacological and non-pharmacological intervention for the management of the neurogenic bowel after spinal cord injury (SCI) were included. Objective: To systematically review the evidence for the management of neurogenic bowel in individuals with SCI. Setting: Literature searches were conducted for relevant articles, as well as practice guidelines, using numerous electronic databases. Manual searches of retrieved articles from 1950 to July 2009 were also conducted to identify literature. Methods: Two independent reviewers evaluated each study's quality, using Physiotherapy Evidence Database scale for RCTs and Downs and Black scale for all other studies. The results were tabulated and levels of evidence assigned. Results: A total of 2956 studies were found as a result of the literature search. On review of the titles and abstracts, 57 studies met the inclusion criteria. Multifaceted programs are the first approach to neurogenic bowel and are supported by lower levels of evidence. Of the non-pharmacological (conservative and non-surgical) interventions, transanal irrigation is a promising treatment to reduce constipation and fecal incontinence. When conservative management is not effective, pharmacological interventions (for example prokinetic agents) are supported by strong evidence for the treatment of chronic constipation. When conservative and pharmacological treatments are not effective, surgical interventions may be considered and are supported by lower levels of evidence in reducing complications. Conclusions: Often, more than one procedure is necessary to develop an effective bowel routine. Evidence is low for non-pharmacological approaches and high for pharmacological interventions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Neurogenic bowel management after spinal cord injury: a systematic review of the evidence

et al. 2010

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“…[9][10][11][12][13] SCI patients lose a variable proportion of their extrinsic autonomic innervation to their gut, depending on the level of injury, whereas the intrinsic enteric nervous system remains intact. 3 The gut intrinsic nervous system may lose integrity with time because of the loss of extrinsic supply.…”

Section: Introductionmentioning

confidence: 99%

Relationship between gut-specific autonomic testing and bowel dysfunction in spinal cord injury patients

et al. 2009

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Study design: Investigation of bowel function in 55 patients and 26 healthy volunteers using radiological, anorectal physiological and laser Doppler blood flow monitoring. Objectives: Bowel dysfunction is common after spinal cord injury (SCI). We aimed to determine whether hindgut testing of autonomic innervation provides insight into presence of symptoms, altered motor function (transit) and level of injury. Setting: St Mark's Hospital, UK and The Spinal Injuries Unit, Royal National Orthopaedic Hospital, UK. Methods: A total of 55 patients with chronic complete SCI and 26 healthy volunteers were studied. Twenty-four patients had lesions above T5 and 31 had lesions below T5. Thirty-five patients complained of constipation: 75% (18/24) of patients with lesions above T5 and 55% (17/31) of those with lesions below T5. Gut transit, rectal electrosensitivity and rectal blood flow were measured. Results: Slow gut transit occurred in 65% of patients and in all the 35 patients complaining of constipation. Delay was pancolonic. All patients had an elevated sensory threshold. The threshold was significantly higher in those with subjective constipation (Po0.01), slow transit (Po0.04) and high SCI (P ¼ 0.046). Mucosal blood flow was lower in SCI patients with constipation (Po0.04) and slow transit (Po0.03). It was higher than normal in high-SCI volunteers (P ¼ 0.056), reflecting loss of sympathetic inhibition. Conclusions: In SCI, subjective constipation correlates closely with slow gut transit. Delay is pancolonic, regardless of the site of lesion. Sensory testing provides evidence for completeness of lesion, offering further evidence for pain transmission through sympathetic pathways. Studies in SCI patients provide further evidence of mucosal blood flow as a marker of altered autonomic innervation.

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“…11 Over 500 sacral anterior root stimulator implants have been done at 34 centers in 14 countries, and approximately 90% are in regular use 4 to 6 times a day.…”

Section: Clinical Applications Of Fes 97mentioning

confidence: 99%

Neural prostheses: clinical applications of functional electrical stimulation in spinal cord injury

Peckham

Creasey

1992

Spinal Cord

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Control of defecation in patients with spinal injuries by stimulation of sacral anterior nerve roots.

Cited by 115 publications

References 1 publication

Neurogenic bowel management after spinal cord injury: a systematic review of the evidence

Neurogenic bowel management after spinal cord injury: a systematic review of the evidence

Relationship between gut-specific autonomic testing and bowel dysfunction in spinal cord injury patients

Neural prostheses: clinical applications of functional electrical stimulation in spinal cord injury

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