Extradural Nerve Anastomosis Technique for Bladder Reinnervation in Spinal Cord Injury

Zhou, Xiao-Ji; Liu, Yongtao; Ma, Jun; Sui, Tao; Ge, Yali; Cao, Xiaojian

doi:10.1097/brs.0000000000000208

Cited by 14 publications

(11 citation statements)

References 42 publications

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“…These findings indicate that nerve transfer can induce recovery of sensation of bladder fullness and possibly the ability to empty the bladder, and thus may be an appropriate surgical treatment for patients who sustain lower motor neuron lesion-induced bladder dysfunction. Cadaver studies by us 2,4,5 and others 11,20 confirmed that nerve transfer for bladder and urethra reinnervation is feasible and generalizable for reinnervation of the lower motor neuron-lesioned human pelvic viscera. This nerve transfer surgery is considered to be well within the technical range of practicing peripheral nerve reconstruction neurosurgeons or plastic surgeons.…”

Section: Discussionmentioning

confidence: 75%

Nerve transfer for restoration of lower motor neuron–lesioned bladder and urethra function: establishment of a canine model and interim pilot study results

Tiwari¹,

Salvadeo²,

Braverman³

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEPrevious patient surveys have shown that patients with spinal cord or cauda equina injuries prioritize recovery of bladder function. The authors sought to determine if nerve transfer after long-term decentralization restores bladder and sphincter function in canines.METHODSTwenty-four female canines were included in this study. Transection of sacral roots and hypogastric nerves (S Dec) was performed in 6 animals, and 7 animals underwent this procedure with additional transection of the L7 dorsal roots (L7d+S Dec). Twelve months later, 3 L7d+S Dec animals underwent obturator-to-pelvic nerve and sciatic-to-pudendal nerve transfers (L7d+S Dec+Reinn). Eleven animals served as controls. Squat-and-void behaviors were tracked before and after decentralization, after reinnervation, and following awake bladder-filling procedures. Bladders were cystoscopically injected with Fluoro-Gold 3 weeks before euthanasia. Immediately before euthanasia, transferred nerves were stimulated to evaluate motor function. Dorsal root ganglia were assessed for retrogradely labeled neurons.RESULTSTransection of only sacral roots failed to reduce squat-and-void postures; L7 dorsal root transection was necessary for significant reduction. Three L7d+S Dec animals showing loss of squat-and-void postures post-decentralization were chosen for reinnervation and recovered these postures 4–6 months after reinnervation. Each showed obturator nerve stimulation–induced bladder contractions and sciatic nerve stimulation–induced anal sphincter contractions immediately prior to euthanasia. One showed sciatic nerve stimulation–induced external urethral sphincter contractions and voluntarily voided twice following nonanesthetized bladder filling. Reinnervation was confirmed by increased labeled cells in L2 and the L4–6 dorsal root ganglia (source of obturator nerve in canines) of L7d+S Dec+Reinn animals, compared with controls.CONCLUSIONSNew neuronal pathways created by nerve transfer can restore bladder sensation and motor function in lower motor neuron–lesioned canines even 12 months after decentralization.

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Section: Discussionmentioning

confidence: 75%

Nerve transfer for restoration of lower motor neuron–lesioned bladder and urethra function: establishment of a canine model and interim pilot study results

Tiwari¹,

Salvadeo²,

Braverman³

et al. 2020

Journal of Neurosurgery: Spine

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“…b) Ventral roots are removed from L5 or S1 above the injured level and connected below the injured level to the S2 or S3 ventral roots that innervate the bladder [133][134][135][136][137]. c) A peripheral nerve is resected and inserted into the ventral tract of the thoracic spinal cord (corticospinal tract) for 4-5 mm and the distal end of the nerve is connected to a neuromuscular junction in a lower limb muscle [138].…”

Section: Nerve Bridgingmentioning

confidence: 99%

Clinical guidelines for neurorestorative therapies in spinal cord injury (2021 China version)

Guo¹,

Feng²,

Sun³

et al. 2021

Journal of Neurorestoratology

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Treatment of spinal cord injury (SCI) remains challenging. Considering the rapid developments in neurorestorative therapies for SCI, we have revised and updated the Clinical Therapeutic Guidelines for Neurorestoration in Spinal Cord Injury (2016 Chinese version) of the Chinese Association of Neurorestoratology (Preparatory) and China Committee of International Association of Neurorestoratology. Treatment of SCI is a systematic multimodal process that aims to improve survival and restore neurological function. These guidelines cover real-world comprehensive neurorestorative management of acute, subacute, and chronic SCI and include assessment and diagnosis, pre-hospital first aid, treatment, rehabilitation, and complication management.

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“…Zheng et al 10 conducted a randomized controlled trial on the contralateral C7 nerve that proved the feasibility of nerve transplantation in the treatment of upper limb motor dysfunction after spastic paralysis. We have improved on this surgical method to a certain extent, as reported in our previous studies 11–14. On the basis of these studies, we considered the possibility of a surgical method to treat lower limb dysfunction caused by hemiplegia.…”

mentioning

confidence: 94%

“…We have improved on this surgical method to a certain extent, as reported in our previous studies. [11][12][13][14] On the basis of these studies, we considered the possibility of a surgical method to treat lower limb dysfunction caused by hemiplegia.…”

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confidence: 99%

Extradural Contralateral Ventral Root Transfer to Treat Lower Limb Motor Dysfunction in Paraplegia

Chang

Cao²,

Wu³

et al. 2022

Spine

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Study Design. Eight cadavers were included in this anatomical study.Objective. This study aimed to confirm the anatomical feasibility of extradural transfer of the contralateral T11 ventral root (VR) to the ipsilateral L2 level and the contralateral L1 VR to the ipsilateral L3 level to restore lower limb function in cases of paraplegia. Summary of Background Data. Motor dysfunction due to hemiplegia significantly affects the daily life of patients. To date, unlike in cases of upper limb dysfunction, there are few studies on the surgical management of lower limb movement dysfunction. Materials and Methods. Eight cadavers were included in this study to confirm the feasibility of the nerve transfer. After separating the VR and dorsal root at each level, the VRs at the T11 and L1 levels were anastomosed with the VRs of L2 and L3, respectively. The length of the VRs of donor roots and the distance between the donor and recipient nerves were measured. H&E staining was performed to verify the number of axons and the cross-sectional area of the VRs. Lumbar x-rays of 60 healthy adults were used to measure the distance between the donor and recipient nerves. Results. After exposing the bilateral extradural each root, the VRs could be easily isolated from the whole root. The distance between the VRs of T11 and L2, L1, and L3 was significantly longer than the length of the donor nerve. Therefore, the sural nerve was used for grafting. The measurements performed on the lumbar x-rays of the 60 healthy adults confirmed the results. The number of axons and cross-sectional area of the VRs were measured. Conclusion.Our study confirmed the anatomical feasibility of transferring the VRs of T11 to L2 and that of L1 to L3 to restore lower limb function in cases of hemiplegia.

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Extradural Nerve Anastomosis Technique for Bladder Reinnervation in Spinal Cord Injury

Abstract: N/A.

Cited by 14 publications

References 42 publications

Nerve transfer for restoration of lower motor neuron–lesioned bladder and urethra function: establishment of a canine model and interim pilot study results

Nerve transfer for restoration of lower motor neuron–lesioned bladder and urethra function: establishment of a canine model and interim pilot study results

Clinical guidelines for neurorestorative therapies in spinal cord injury (2021 China version)

Extradural Contralateral Ventral Root Transfer to Treat Lower Limb Motor Dysfunction in Paraplegia

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