M M Rasmussen1,2, K Krogh3, D Clemmensen2, H Tankisi4, A Fuglsang-Frederiksen4, Y Rawashdeh5, H Bluhme6, P Christensen1. 1. Pelvic floor unit, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark. 2. Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark. 3. Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark. 4. Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark. 5. Department of Urology, Aarhus University Hospital, Aarhus, Denmark. 6. Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Aarhus, Denmark.
Abstract
STUDY DESIGN: Prospective cohort study. OBJECTIVE: Although introduced for neurogenic bladder dysfunction, it has been suggested that the artificial somato-autonomic reflex arch alleviates neurogenic bowel dysfunction (NBD). We aimed at evaluating the effects of the reflex arch on NBD. SETTING: Denmark. METHODS: Ten subjects with supraconal spinal cord injury (SCI) (nine males, median age 46 years) had an anastomosis created between the ventral part of the fifth lumbar or first sacral nerve root and the ventral part of the second sacral nerve root. Standardized assessment of segmental colorectal transit times with radiopaque markers, evaluation of scintigraphic assessed colorectal emptying upon defecation, scintigraphic assessment of colorectal transport during stimulation of the reflex arch, standard anorectal physiology tests and colorectal symptoms were performed at baseline and 18 months after surgery. RESULTS: No significant change was observed in colorectal emptying upon defecation (median 31% of the rectosigmoid at baseline vs 75% at follow-up, P=0.50), no movement of colorectal contents was observed during stimulation of the reflex arch. Segmental colorectal transit times, anal sphincter pressures and rectal capacity did not change, and no change was seen in NBD score (median 13.5 (baseline) vs 12.5 (follow-up), P=0.51), St Marks fecal incontinence score (4.5 vs 5.0, P=0.36) and Cleveland constipation score (6.0 vs 8.0, P=0.75). CONCLUSIONS: The artificial somato-autonomic reflex arch has no effect on bowel function in subjects with supraconal SCI.
STUDY DESIGN: Prospective cohort study. OBJECTIVE: Although introduced for neurogenic bladder dysfunction, it has been suggested that the artificial somato-autonomic reflex arch alleviates neurogenic bowel dysfunction (NBD). We aimed at evaluating the effects of the reflex arch on NBD. SETTING: Denmark. METHODS: Ten subjects with supraconal spinal cord injury (SCI) (nine males, median age 46 years) had an anastomosis created between the ventral part of the fifth lumbar or first sacral nerve root and the ventral part of the second sacral nerve root. Standardized assessment of segmental colorectal transit times with radiopaque markers, evaluation of scintigraphic assessed colorectal emptying upon defecation, scintigraphic assessment of colorectal transport during stimulation of the reflex arch, standard anorectal physiology tests and colorectal symptoms were performed at baseline and 18 months after surgery. RESULTS: No significant change was observed in colorectal emptying upon defecation (median 31% of the rectosigmoid at baseline vs 75% at follow-up, P=0.50), no movement of colorectal contents was observed during stimulation of the reflex arch. Segmental colorectal transit times, anal sphincter pressures and rectal capacity did not change, and no change was seen in NBD score (median 13.5 (baseline) vs 12.5 (follow-up), P=0.51), St Marks fecal incontinence score (4.5 vs 5.0, P=0.36) and Cleveland constipation score (6.0 vs 8.0, P=0.75). CONCLUSIONS: The artificial somato-autonomic reflex arch has no effect on bowel function in subjects with supraconal SCI.
Authors: Gerald F Tuite; Bruce B Storrs; Yves L Homsy; Sarah J Gaskill; Ethan G Polsky; Margaret A Reilly; Ignacio Gonzalez-Gomez; S Parrish Winesett; Luis F Rodriguez; Carolyn M Carey; Sharon A Perlman; Lisa Tetreault Journal: J Neurosurg Pediatr Date: 2013-05-10 Impact factor: 2.375
Authors: Anthony F DiMarco; Robert T Geertman; Kutaiba Tabbaa; Gregory A Nemunaitis; Krzysztof E Kowalski Journal: Arch Phys Med Rehabil Date: 2020-11-05 Impact factor: 4.060