Results of the Treatment of Neurogenic Bladder Dysfunction in Spinal Cord Injury by Sacral Posterior Root Rhizotomy and Anterior Sacral Root Stimulation

Abstract

Purpose: We evaluated the results of treatment of neurogenic bladder dysfunction in spinal cord injury by sacral posterior root rhizotomy and anterior sacral root stimulation using the Finetech-Brindley stimulator.* Materials and Methods: In 52 patients with spinal cord lesions and urological problems due to hyperreflexia of the bladder complete posterior sacral root rhizotomy was performed and a Finetech-Brindley sacral anterior root stimulator was implanted. All patients were evaluated and followed with a strict protocol. A minimal 6-month foliowup is available in 47 cases.Results: Complete continence was achieved in 43 of the 47 patients with 6 months of followup. A significant increase in bladder capacity was attained in all patients. Residual urine signifi cantly decreased, resulting in a decreased incidence of urinary tract infections. In 2 patients upper tract dilatation resolved. In 3 patients rhizotomy was incomplete and higher sectioning of the roots was necessary. One implant had to be removed because of infection.Conclusions: The treatment of neurogenic bladder dysfunction in spinal cord injury by anterior sacral root stimulation with the Finetech-Brindley stimulator in combination with sacral poste rior root rhizotomy provides excellent results with limited morbidity.

Functional Reinnervation of the Canine Bladder after Spinal Root Transection and Genitofemoral Nerve Transfer at One and Three Months after Denervation

“…A recent survey of SCI patients indicates that restoration of bladder function is an important priority and in paraplegics is considered more important than recovery of walking (Anderson, 2004). Over the past several decades, functional electrical stimulation (FES) of sacral ventral roots has been developed and applied clinically to restore motor control after upper motor lesions above the T12-L1 vertebral level, which spare the S2-4 spinal cord segments where the parasympathetic nerve cell bodies innervating the urinary bladder are located (Brindley et al, 1986;Jezernik et al, 2002;Van Kerrebroeck et al, 1996). Injuries below the conus medullaris, including injuries to the conus itself and the cauda equina, result in a lower motoneuron (LMN) lesion, leading to a flaccid paralysis of the urinary bladder such that the bladder does not contract when filled (detrusor areflexia) and often results in a competent but non-relaxing smooth muscle sphincter and a striated sphincter that retains some fixed tone but is not under voluntary control.…”

Forty-five-year follow-up on the renal function after spinal cord injury

“…Sacral rhizotomy, also known as sacral deafferentation (SDAF), has achieved some success in reducing DO (16,(223)(224)(225)(226)(227), but it is used nowadays mostly as an adjuvant to sacral anterior root stimulation (228)(229)(230)(231)(232)(233)(234)(235)(236)(237)(238)(239). Alternatives for rhizotomy are sought in this treatment combination (240)(241)(242).…”

“…The urethral sphincter efferents are also stimulated, but as the striated muscle relaxes faster than the smooth muscle of the detrusor, a so-called 'post-stimulus voiding' will occur. This approach has been successful in highly selected patients (228)(229)(230)(231)(232)(233)(234)(235)(236)(237)(238)(239). By changing the stimulation parameters, this method can also induce defecation or erection.…”

Electrical stimulation for the treatment of lower urinary tract dysfunction after spinal cord injury

“…The SARS system targets efferent nerve fibers emerging from the sacral spinal cord to produce bladder contraction 50 and provide efficient, on-demand voiding and a significant reduction in residual volumes and urinary tract infections, as well as bowel emptying. 40,52 However, treatment of NDO and DSD required a concomitant posterior rhizotomy. Transection of the sacral dorsal roots ( posterior rhizothomy) performed in combination with SARS to increase bladder capacity and compliance and improve voiding efficiency is effective, 53 but irreversibly eliminates reflex erection, reflex micturition and any remaining pelvic sensation.…”