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Bing J, You H, Dai Y, Ding Y. Progress and research trends in neurogenic bladder after spinal cord injury bibliometric analysis based on web of science database: An observational study. Medicine (Baltimore) 2024; 103:e38491. [PMID: 38875432 PMCID: PMC11175955 DOI: 10.1097/md.0000000000038491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 06/16/2024] Open
Abstract
Neurogenic bladder (NB) is a significant complication that often occurs after spinal cord injury. It results from urinary dysfunction caused by the injury, disrupting the normal neural control of the bladder and urethra. Symptoms of NB can include urinary frequency, urgency, incontinence, and retention, all of which can greatly impact the quality of life of affected individuals. While there are articles and reviews on NB, fewer specifically address NB following spinal cord injury. This study examined 1095 publications from January 1, 2000, to March 27, 2024, in the Web of Science core database using bibliometric software like VOSviewer, CiteSpace, and Bibliometrics. The analysis revealed an increasing trend in the number of publications, with the United States and China leading in research output. Professor Jeremy B. Myers from the University of Utah had the highest number of publications, while the University of Michigan and the University of Pittsburgh were the institutions with the most publications. The journal Neurourology and Urodynamics had the highest number of articles, and common keywords included management, quality of life, and dysfunction, highlighting key areas of focus for scholars.
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Affiliation(s)
- Jingyu Bing
- Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong
| | - Haihua You
- Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong
| | - Yaowen Dai
- Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong
| | - Yunxia Ding
- Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong
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Xiang YT, Wu JJ, Ma J, Xing XX, Zhang JP, Hua XY, Zheng MX, Xu JG. Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review. Int J Surg 2024; 110:3814-3826. [PMID: 38935818 PMCID: PMC11175768 DOI: 10.1097/js9.0000000000001267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/21/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND The review highlights recent advancements and innovative uses of nerve transfer surgery in treating dysfunctions caused by central nervous system (CNS) injuries, with a particular focus on spinal cord injury (SCI), stroke, traumatic brain injury, and cerebral palsy. METHODS A comprehensive literature search was conducted regarding nerve transfer for restoring sensorimotor functions and bladder control following injuries of spinal cord and brain, across PubMed and Web of Science from January 1920 to May 2023. Two independent reviewers undertook article selection, data extraction, and risk of bias assessment with several appraisal tools, including the Cochrane Risk of Bias Tool, the JBI Critical Appraisal Checklist, and SYRCLE's ROB tool. The study protocol has been registered and reported following PRISMA and AMSTAR guidelines. RESULTS Nine hundred six articles were retrieved, of which 35 studies were included (20 on SCI and 15 on brain injury), with 371 participants included in the surgery group and 192 in the control group. These articles were mostly low-risk, with methodological concerns in study types, highlighting the complexity and diversity. For SCI, the strength of target muscle increased by 3.13 of Medical Research Council grade, and the residual urine volume reduced by more than 100 ml in 15 of 20 patients. For unilateral brain injury, the Fugl-Myer motor assessment (FMA) improved 15.14-26 score in upper extremity compared to 2.35-26 in the control group. The overall reduction in Modified Ashworth score was 0.76-2 compared to 0-1 in the control group. Range of motion (ROM) increased 18.4-80° in elbow, 20.4-110° in wrist and 18.8-130° in forearm, while ROM changed -4.03°-20° in elbow, -2.08°-10° in wrist, -2.26°-20° in forearm in the control group. The improvement of FMA in lower extremity was 9 score compared to the presurgery. CONCLUSION Nerve transfer generally improves sensorimotor functions in paralyzed limbs and bladder control following CNS injury. The technique effectively creates a 'bypass' for signals and facilitates functional recovery by leveraging neural plasticity. It suggested a future of surgery, neurorehabilitation and robotic-assistants converge to improve outcomes for CNS.
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Affiliation(s)
- Yun-Ting Xiang
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine
| | - Jia-Jia Wu
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Jie Ma
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Xiang-Xin Xing
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Jun-Peng Zhang
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine
| | - Xu-Yun Hua
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Mou-Xiong Zheng
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Jian-Guang Xu
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
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Lewis MJ, Granger N, Jeffery ND. Emerging and Adjunctive Therapies for Spinal Cord Injury Following Acute Canine Intervertebral Disc Herniation. Front Vet Sci 2020; 7:579933. [PMID: 33195591 PMCID: PMC7593405 DOI: 10.3389/fvets.2020.579933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/04/2020] [Indexed: 11/13/2022] Open
Abstract
Some dogs do not make a full recovery following medical or surgical management of acute canine intervertebral disc herniation (IVDH), highlighting the limits of currently available treatment options. The multitude of difficulties in treating severe spinal cord injury are well-recognized, and they have spurred intense laboratory research, resulting in a broad range of strategies that might have value in treating spinal cord-injured dogs. These include interventions that aim to directly repair the spinal cord lesion, promote axonal sparing or regeneration, mitigate secondary injury through neuroprotective mechanisms, or facilitate functional compensation. Despite initial promise in experimental models, many of these techniques have failed or shown mild efficacy in clinical trials in humans and dogs, although high quality evidence is lacking for many of these interventions. However, the continued introduction of new options to the veterinary clinic remains important for expanding our understanding of the mechanisms of injury and repair and for development of novel and combined strategies for severely affected dogs. This review outlines adjunctive or emerging therapies that have been proposed as treatment options for dogs with acute IVDH, including discussion of local or lesion-based approaches as well as systemically applied treatments in both acute and subacute-to-chronic settings. These interventions include low-level laser therapy, electromagnetic fields or oscillating electrical fields, adjunctive surgical techniques (myelotomy or durotomy), systemically or locally-applied hypothermia, neuroprotective chemicals, physical rehabilitation, hyperbaric oxygen therapy, electroacupuncture, electrical stimulation of the spinal cord or specific peripheral nerves, nerve grafting strategies, 4-aminopyridine, chondroitinase ABC, and cell transplantation.
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Affiliation(s)
- Melissa J Lewis
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, United States
| | - Nicolas Granger
- The Royal Veterinary College, University of London, Hertfordshire, United Kingdom.,CVS Referrals, Bristol Veterinary Specialists at Highcroft, Bristol, United Kingdom
| | - Nick D Jeffery
- Department of Small Animal Clinical Sciences, Texas A & M College of Veterinary Medicine and Biomedical Sciences, College Station, TX, United States
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Reducing Neuron Apoptosis in the Pontine Micturition Center by Nerve Root Transfer for Restoration of Micturition Function after Spinal Cord Injury. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5615097. [PMID: 32802856 PMCID: PMC7424370 DOI: 10.1155/2020/5615097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 11/17/2022]
Abstract
Objective The rate of neuronal apoptosis increases after spinal cord injury (SCI). Anastomosing the normal nerve roots above the SCI level to the injured sacral nerve roots can enhance the functional recovery of neurons. Therefore, we evaluated the effect of sacral nerve root transfer after SCI on pontine neuronal survival. Methods Sprague–Dawley rats were randomly divided into three groups: Group A, reconstruction of afferent and efferent nerve pathways of the bladder after SCI; Group B, SCI only; and Group C, control group. We examined pontine neuronal morphology using hematoxylin and eosin (H&E) staining after SCI and nerve transfer. Bcl-2 and Bax protein expression changes in the pontine micturition center were quantified by immunohistochemistry. The number of apoptotic neurons was determined by TUNEL staining. We examined pontine neuronal apoptosis by transmission electron microscopy (TEM) at different time points. Results H&E staining demonstrated that the number of neurons had increased in Group A, but more cells in Group B displayed nuclear pyknosis, with the disappearance of the nucleus. Compared with Group B, Group A had significantly higher Bcl-2 expression, significantly lower Bax expression, and a significantly higher Bcl-2/Bax ratio. The number of apoptotic neurons and neuron bodies in Group A was significantly lower than that in Group B, as indicated by TUNEL staining and TEM. Conclusions These findings demonstrate that lumbosacral nerve transfer can reduce neuronal apoptosis in the pontine micturition center and enhance functional recovery of neurons. This result further suggests that lumbosacral nerve transfer can be used as a new approach for reconstructing bladder function after spinal cord injury.
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Yu R, Hou C, Lin H, Zhao J, Zong H, Lin Y. [Experimental study of urinary center change in pons after conus medullaris injury in rats]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:75-79. [PMID: 29806370 DOI: 10.7507/1002-1892.201708126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/26/2022]
Abstract
Objective To observe the structural changes of urinary center and the expression of Bcl-2 after conus medullaris injury in rats brain so as to explore the possible influence factors of degeneration in brain. Methods Thirty-six adult Sprague-Dawley rats were randomly divided into experimental group ( n=30) and control group ( n=6). In the experimental group, the conus medullaris injury model was established by cutting off the spinal nerve below L 4, and no treatment was done in the control group. The modeling operations in the experimental group were successful, and 2 rats died at 3 months and 5 months after modeling operation respectively, which may be caused by renal failure or urinary tract infection. In the experimental group, 6, 6, 6, 5, and 5 rats were killed at 1 day, 1 week, and 1, 3, 6 months after operation respectively, and 1 rat was killed at each time point in the control group. The dorsolateral tissue of the pontine tegmentum was harvested to perform HE staining and Bcl-2 immunohistochemical SP staining. Results HE staining showed that there was no obvious difference between the experimental group and the control group at 1 day after operation, the neurons were densely packed, arranged neatly, and the nucleoli were clear; at 1 week, the space between the neurons in the experimental group were slightly widened; at 1 month, nucleus retraction in some neurons happened in the experimental group; at 3 and 6 months, the nuclei in the experimental group were more and more condensed, and even some cells disappeared. Bcl-2 immunohistochemical SP staining showed that the expression of Bcl-2 in the control group was weakly positive. The positive expression of Bcl-2 was found at 1 day after operation in the experimental group; the positive expression of Bcl-2 at 7 days after operation was significantly higher than that in the control group, and reached the peak; the positive expression of Bcl-2 decreased gradually at 1, 3, and 6 months after modeling operation, but it was still higher than that of the control group. Conclusion The urinary center appears structure degeneration and necrocytosis after conus medullaris injury in rats brain. The elevated expression of Bcl-2 may be associated with brain tissue repair and function remodeling.
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Affiliation(s)
- Ronghua Yu
- Second Military Medical University, Shanghai, 200433, P.R.China;Department of Orthopaedics, Changzheng Hospital, Shanghai, 200003, P.R.China
| | - Chunlin Hou
- Department of Orthopaedics, Changzheng Hospital, Shanghai, 200003,
| | - Haodong Lin
- Department of Orthopaedics, Changzheng Hospital, Shanghai, 200003, P.R.China
| | - Jianguo Zhao
- Department of Orthopaedics, Changzheng Hospital, Shanghai, 200003, P.R.China
| | - Haiyang Zong
- Department of Orthopaedics, Changzheng Hospital, Shanghai, 200003, P.R.China
| | - Yaofa Lin
- Department of Orthopaedics, Changzheng Hospital, Shanghai, 200003, P.R.China
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Lam Van Ba O, Barbe MF, Caremel R, Aharony S, Loutochin O, Jacques L, Wood MW, Tiwari E, Tuite GF, Campeau L, Corcos J, Ruggieri MR. Lumbar to sacral root rerouting to restore bladder function in a feline spinal cord injury model: Urodynamic and retrograde nerve tracing results from a pilot study. Neurourol Urodyn 2018; 37:153-162. [PMID: 29314212 DOI: 10.1002/nau.23394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 08/05/2017] [Indexed: 10/18/2022]
Abstract
AIMS Lumbar to sacral rerouting surgery can potentially allow voiding via a skin-central nervous system-bladder reflex pathway. Here, we assessed if this surgery was effective in treating neurogenic bladder dysfunction/sphincter in felines. METHODS Eight cats underwent spinal cord transection (SCT) at thoracic level 10/11. Unilateral L7 to S1 ventral root anastomosis was performed 1 month later in six cats. Two cats served as transection-only controls. Electrical and manual stimulation of L6-S1 dermatomes, and urodynamics were performed at 3, 5, 7, and 9/10 months post transection. At 9/10 months, cats were also evaluated by direct electrophysiological testing of anastomosed roots with urodynamics, then tissue collection and examination of the root anastomosis site and lumbosacral cord ventral horns for cells retrogradely labeled from tracer dye injected 2 weeks earlier into the bladder wall. RESULTS At 9/10 months, four of six rerouted cats exhibited increased detrusor pressure provoked by cutaneous stimulation, one cat bilaterally. Two cats presented with a voiding stream after ipsilateral cutaneous stimulation at 7 and 9 months. All six rerouted animals showed regrowth of axons from the L7 ventral horn to the bladder, although some aberrant axonal regrowth was also observed. CONCLUSION L7 to S1 ventral root rerouting below the level of SCT showed successful axonal regrowth to the bladder from the L7 spinal cord segment in all rerouted animals, and induced increased detrusor pressure response to cutaneous stimulation in a subset. This feasibility study paves the way for future animal studies for bladder reinnervation.
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Affiliation(s)
- Ornella Lam Van Ba
- Department of Urology, Lady Davis Research Institute and McGill University, Montreal, Quebec, Canada
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Romain Caremel
- Department of Urology, Lady Davis Research Institute and McGill University, Montreal, Quebec, Canada
| | - Shachar Aharony
- Department of Urology, Lady Davis Research Institute and McGill University, Montreal, Quebec, Canada
| | - Oleg Loutochin
- Department of Urology, Lady Davis Research Institute and McGill University, Montreal, Quebec, Canada
| | - Line Jacques
- Department of Neurosurgery, Lady Davis Research Institute and McGill University, Montreal, Quebec, Canada
| | - Matthew W Wood
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Ekta Tiwari
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Gerald F Tuite
- Neuroscience Institute, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida.,Shriners Hospital, Philadelphia, Pennsylvania
| | - Lysanne Campeau
- Department of Urology, Lady Davis Research Institute and McGill University, Montreal, Quebec, Canada
| | - Jacques Corcos
- Department of Urology, Lady Davis Research Institute and McGill University, Montreal, Quebec, Canada
| | - Michael R Ruggieri
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.,Shriners Hospital, Philadelphia, Pennsylvania.,Department of Electrical and Computer Engineering, Temple University, Philadelphia, Pennsylvania.,Department of Pharmacology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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Tang J, Ma J, Yang L, Huang X, Ge Y, Sui T, Wei Z, Cao X. The feasibility study of extradural nerve anastomosis technique for canine bladder reinnervation after spinal cord injury. J Spinal Cord Med 2016; 39:679-685. [PMID: 27858587 PMCID: PMC5137576 DOI: 10.1080/10790268.2016.1209889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Intradural nerve anastomosis for bladder innervation has been demonstrated to be useful. However, its clinical application remains limited because of the complex surgery, its complications and extensive bony destruction. The purpose of the current study was to demonstrate the feasibility of extradural spinal root anastomosis for bladder innervation in canines. METHODS Ten beagle dogs were used. The length of the extradural segment of the nerve root, upper nerve root outlet (the point at which it emerges from the spinal dura mater) to S2 (dS2), the S3 (dS3) nerve root outlet distance, and the diameters of the extradural spinal roots were measured. The numbers of nerve fibers from L6 to S3 ventral roots were calculated using immunohistochemical staining. RESULTS The extradural spinal roots could be divided into a ventral root (VR) and a dorsal root (DR) before the ganglionic enlargement of the dorsal root, and the extradural motor nerve roots situate ventrally to their corresponding sensory nerve roots. The extradural nerve root lengths of S1 and parts of L7 were longer than the corresponding dS2. The numbers of nerve and motor nerve fibers, and the diameters of extradural nerve roots, were gradually descending from L6 to S3. CONCLUSION The S1 VRs and parts of the L7 VRs can be extradurally anastomosed to the S2 nerves without tension. A nerve graft was needed for extradural anastomosis of L6 VRs and parts of L7 VRs to S2 VRs. This study demonstrated the feasibility of extradural spinal nerve anastomosis for treating neurogenic bladder in canines.
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Affiliation(s)
- Jian Tang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jun Ma
- Department of Orthopedics, Affiliated Suqian Hospital of Xuzhou Medical College, Suqian, Jiangsu, China
| | - Lei Yang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinpeng Huang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yingbin Ge
- Department of Physiology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Tao Sui
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhongqing Wei
- Department of Urology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangs”u China
| | - Xiaojian Cao
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China,Correspondence to: Xiaojian Cao, Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, NO. 300, Guangzhou Road, Nanjing City, Jiangsu Province, China.
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Cao XJ, Feng SQ, Fu CF, Gao K, Guo JS, Guo XD, He XJ, Huang ZW, Li ZH, Liu L, Liu RH, Lü HZ, Mei XF, Ning B, Ning GZ, Qian CH, Qin J, Qu YZ, Saijilafu, Shi B, Sui T, Sun TS, Wang J, Wen JK, Xiao J, Xu B, Xu HD, Yu PP, Zhang ZC, Zhou Y, Zhou YL. Repair, protection and regeneration of spinal cord injury. Neural Regen Res 2015; 10:1953-75. [PMID: 26889184 PMCID: PMC4730820 DOI: 10.4103/1673-5374.172314] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Extradural nerve anastomosis technique for bladder reinnervation in spinal cord injury: anatomical feasibility study in human cadavers. Spine (Phila Pa 1976) 2014; 39:635-41. [PMID: 24430721 DOI: 10.1097/brs.0000000000000208] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An anatomic study of extradural spinal root in 9 embalmed cadavers. OBJECTIVE To ascertain the anatomical parameters of the extradural spinal root and to demonstrate the feasibility of spinal root anastomoses without opening the spinal dura mater. SUMMARY OF BACKGROUND DATA Intradural anastomosis of the spinal root has made breakthrough progress in treating neurogenic bladder in spinal cord injury. However, because of the complex surgical procedures and extensive bony destruction, its clinical use is not widely promoted. METHODS Nine formalin-fixed cadavers were used. The distance between the nerve root outlet and ganglion center, the neighboring nerve root-outlet distance, and the gross anatomy of the extradural spinal root were measured with a surgical microscope. The number of nerve fibers from the T7 to S4 ventral roots (VRs) was calculated by immunohistochemical staining. RESULTS The longest and shortest lengths of the extradural spinal root were observed at the S4 and T7 levels, with average values of 33.29 and 6.06 mm, respectively. The longest distance between the adjacent nerve root outlets was observed at L1-L2 (mean, 29.16 mm), and shortest at S3-S4 (mean, 11.79 mm). After leaving the dural sac, the spinal root descends in the spinal canal until reaching the corresponding intervertebral foramina, and the motor nerve roots still lie ventrally to the sensory nerve roots. The largest and smallest numbers of nerve fibers were observed at the L3 and S4 levels (mean, 9169 and 1356, respectively). CONCLUSION The dorsal roots and VRs can both be successfully harvested and identified outside the dural sac. The S1 VR can be anastomosed to the S2 VR extradurally without nerve grafts. For extradural neuroanastomosis of the thoracic VRs to the S2 VR, a nerve graft is required. In addition, there are a sufficient number of nerve fibers for functional bladder recovery at the T7-T12 and S1 levels. This study supports the feasibility of extradural spinal root anastomosis as a modified surgical method for treating neurogenic bladder. LEVEL OF EVIDENCE N/A.
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