Neurogenic bladder and bowel dysfunction after spinal cord injury (SCI) constitutes a major medical and social problem. Electrical stimulation has been in focus for many decades in restoring functional micturition, but it is still not the definitive solution for the majority of the SCI patients. An alternative approach has been developed by Xiao et al. (Xiao et al. 2006), an artificial somatic-autonomic reflex pathway procedure in the form of ventral root microanastomosis, usually between the L5 and S2/3 ventral roots. The L5 dorsal root was left intact as the trigger of micturition after axonal regeneration. Studies by this group have provided a novel method for controlling bladder function in patients with complete suprasacral SCI (Xiao et al. 2003), although this has never been confirmed by a prospective, multidisciplinary study.

At Aarhus University Hospital, the Department of Neurosurgery started to carry out this operation in a prospective study in collaboration with the departments of surgery, urology, hepatogastroenterology and clinical neurophysiology (Rasmussen et al. 2011). From a neurophysiological point of view, a broad spectrum of nerve conduction studies (NCS) and electromyography (EMG) including pelvic floor EMG before and one and a half year after operation were planned. The role of the neurophysiological examinations was planned to be the selection of patients for operation by exclusion of peripheral nerve disorders as well as having a status before operation in order to compare postoperative findings.

Neurophysiological guidance has also been used during surgery to indicate L5 and S2/S3 ventral roots for the anastomosis. The preliminary neurophysiological results showed surprisingly high incidence of fibrillations (fibs) and positive sharp waves (PSWs) in SCI in contrast to the generally accepted opinion that fibs and PSWs are signs of peripheral neuromuscular lesion. Correlations between neurophysiological findings and urodynamic, anal physiological and clinical results will probably improve the understanding of the pain, spasticity, urinary and bowel dysfunction as well as therapeutic approaches such as nerve anastomosis in SCI.

Contact

Hatice Tankisi, Associate Professor, MD, PhD, hatitank@rm.dk