Neurourologic findings in patients with traumatic thoracolumbar vertebra junction lesions.
OBJECTIVE
To investigate neurourologic involvement in injuries to the thoracolumbar vertebra junction with magnetic resonance imaging (MRI) and electrophysiologic and urodynamic measurements and to characterize the neurogenic mechanisms of voiding dysfunctions.


METHODS
Baseline comparisons among 3 anatomic groups before neural repair.


METHODS
Tertiary care center.


METHODS
Thirty-five T11 to L2 spinal cord injury patients consecutively admitted to a rehabilitation unit. Eight patients (Group 1) had above-conus lesions without denervation and polyphasic waves revealed in the anal sphincter electromyography; 13 patients (Group 2) had conal and/or above-conus lesions and anal sphincter electromyographic abnormalities; and 14 patients (Group 3) had below-conus lesions and anal sphincter electromyographic abnormalities.


METHODS
Comparison of features identified on pudendal nerve terminal motor latency, urethral pressure profiles, and multichannel voiding pressure-flow study.


RESULTS
The pudendal nerve terminal motor latency in Group 3, showing a significantly higher abnormal ratio (100%; p =.011, Fisher's exact test), indicated that cauda equina lesions might be the cause. Urodynamic data from Group 3 showed a significant decrease in maximal urethral closure pressure (48 +/- 17cm H2O, p =.0022, analysis of variance [ANOVA], repeated measure) and an increase in bladder capacity (429 +/- 194mL, p =.037, ANOVA, repeated measure). There were no significant changes in the other groups.


CONCLUSIONS
Neurourologic abnormalities are less predictable with injuries to thoracolumbar junction, except in patients with cauda equina lesions.
Neuro-urodynamic Laboratory, Department of PM&R, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan. tychuang@vghtpe.gov.tw
T Y
TY
Chuang
H
H
Cheng
R C
RC
Chan
S C
SC
Chiang
W Y
WY
Guo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002420:Cauda Equina; D004576:Electromyography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000145:classification / Q000150:complications / Q000175:diagnosis* / Q000534:rehabilitation; D013124:Spinal Injuries / Q000145:classification / Q000150:complications / Q000175:diagnosis* / Q000534:rehabilitation; D014555:Urination Disorders / Q000175:diagnosis / Q000209:etiology*; D014563:Urodynamics