Reinnervation of the neurogenic bladder in the late period of the spinal cord trauma

Abstract

Study design: Intercostal nerve to spinal nerve root anastomosis in chronic spine-injured patients. Objectives: To analyze the effectiveness of neurogenic bladder reinnervation in spinal cordinjured patients through artificial creation of sprouting (intercostal nerve to spinal nerve root anastomosis). Setting: Center of Neurosurgery, Moscow, Russia. Operations were performed by Professor A Livshits. (At present, Professor A Livshits is working at the Spinal Care Unit, Meir General Hospital, Kfar Saba, Israel.) Methods: A total of 11 patients with spinal cord injury of the L1 level were operated on in the late (chronic) stage. The neurological status and urodynamics were investigated before and 12 months after operation. A laminectomy from T11 to L3 was performed. Next, a neurolysis of the 11th and 12th intercostal nerves was carried out, at a distance of 20-21 cm, and transferred to the vertebral canal. The S2-S3 roots were then cut in their proximal portion and anastomosed end-to-end to the intercostal nerves. The results of urodynamic studies were calculated by the Wilcoxon signed rank test for comparison before and 12 months after operation. Results of urodynamic studies: Bladder capacity (ml) before operation -489779, after operation -350739, urine volume (ml) before -18.2717, after -306.4739.8, residual urine (ml) before -459799.4, after -50711.8. Detrusor tone (rel. units) before -0.671.5, after 1.270.2; voiding pressure (cmH 2 O) before -4.475.2, after -30.574.9. Force of detrusor contraction before -575.8, after -32.875.5. Sphincter resistance (cmH 2 O) before -6.573.8, after -21.174.2. Significant improvements in bladder function were observed during the 10th to 12th postoperative months. Restoration of reflex voiding occurred in all patients; in eight of the 11 paresthesic in the groin and scrotum and reappearance of the bulbocavernous, anal and cremasteric reflexes were noted. Conclusion: These results suggest that a restitutive process occurs in the bladder under novel conditions of its nerve supply provided by the intercostal nerve and by new connections established between it and the bladder nerves. Spinal cord lesions that might benefit from nerve crossover surgery would be located at the conus, so functional intercostal nerves could be connected to sacral roots to bypass the injury in an attempt to restore central connections to the bladder.

The diameters and number of nerve fibers in spinal nerve roots

“…In recent decades, some scholars have partially reconstructed variable nerve function under the level of SCI by different methods of neuroanastomosis, which provides a new approach for the treatment of paraplegia. [3][4][5][6] In order to improve the therapeutic effect, the anatomical and histological features of spinal nerve roots have important clinical significance. In this study, we investigate the microstructure, diameter, and nerve fiber quantity of spinal nerve roots from C1 to S5 to provide fundamental data for spinal nerve root microanastomosis treatment.…”

Motor and sensitive axonal regrowth after multiple intercosto-lumbar neurotizations in a sheep model

“…Multiple lumbar root neurotizations with lower intercostal nerves have been proposed by some authors as being a new surgical procedure in order to treat neurological deficits after spinal cord lesions. 8,15,17,19,20 Using this technique, the use of the spinal cord and intercostal nerves above the spinal cord lesion avoids axonal regrowth having to go through the injured central nervous system. As a consequence, only the lesions of the cauda equina and conus medullaris can be treated by such lower intercostal nerve neurotizations.…”

“…Lang et al 17 have, however, recently reported their use of lower intercostal nerves for neurotization of the lower limb in humans. According to the recent preliminary clinical applications reported by Livshits et al 15 and Sievert et al, 20 a potentially more viable strategy may be through neurotization of the sacral plexus to improve bladder and sexual dysfunction after spinal cord lesions.…”

“…[8][9][10][11][12][13][14] Neurotization of lumbar roots with lower intercostal nerves is a potential way to treat neurological deficits after spinal cord injury. 8,10,[15][16][17] The sheep spine is a useful model for experiments evaluating bony or neurological structures of the thoracic and lumbar spine. We have devised an experiment to examine the feasibility of neurotization of three lumbar roots using lower intercostal nerves after hemisection of the sheep spinal cord.…”

Terminolateral Neurorrhaphy between Somatic Nerve and Autonomic Nerve

“…Neurogenic voiding dysfunction and bowel dysfunction resulting from neural tube defects and spinal cord injury (SCI) has been a worldwide medical problem. In the past decades, many clinicians tried to apply various methods for the treatment of neurogenic bladder and bowel dysfunction including drugs, intermittent catheterization, electronic stimulation of sacral nerve roots and so on [39][40][41][42][43][44][45]. However, the effects of these efforts were not ideal.…”