Urologic function after experimental cauda equina compression. Cystometrograms versus cortical-evoked potentials.
Twenty female beagle dogs underwent an L6-7 laminectomy and six dogs each had 25, 50 or 75% constriction of the cauda equina and 2 control dogs had laminectomy only. Cystometrograms were performed pre- and post-operatively and three months after constriction. Cortical evoked potentials were monitored pre- and post-operatively and monthly for three months. After three months of constriction, the cauda equina of these dogs in each group was examined histologically and vascular circulation was examined by latex and India ink injection (Spalteholz technique). The control dogs had normal CMGs and CEPs. Twenty-five percent constriction caused no CMG changes and mild CEP changes. Fifty percent constriction caused no statistically significant CMG changes, major CEP changes and venous congestion of the nerve roots and dorsal root ganglia. Seventy-five percent constriction produced severe CMG changes with detrusor areflexia, increased bladder capacity and clinical incontinence. CEPs also had marked deterioration. Vascular analysis revealed severe arterial narrowing at the level of constriction and venous congestion of the nerve roots and dorsal root ganglia. Blockage of axoplasmic flow and nerve root atrophy was seen in all dogs with 75% constriction. Cortical evoked potentials were the most sensitive predictor of neural compression. CMGs were not sensitive until severe compression was achieved. Bladder dysfunction, i.e., detrusor areflexia, appears to occur with blockage of axoplasmic flow and early sensory changes occur with neurovenous congestion.
Delamarter
R B
RB
Division of Orthopaedic Surgery, UCLA School of Medicine.
Bohlman
H H
HH
Bodner
D
D
Biro
C
C
D000818:Animals; D002420:Cauda Equina / Q000502:physiology*; D004285:Dogs; D005071:Evoked Potentials / Q000502:physiology; D005260:Female; D007796:Laminectomy; D008365:Manometry / Q000379:methods; D009408:Nerve Compression Syndromes / Q000503:physiopathology*; D001743:Urinary Bladder / Q000294:innervation* / Q000503:physiopathology; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000503:physiopathology*