Outcomes of lumbar to sacral nerve rerouting for spina bifida.
OBJECTIVE
Restoring bladder and bowel function in spina bifida by creation of a skin-central nervous system-bladder reflex arc via lumbar to sacral nerve rerouting has a reported success rate of 87% in China. We report 1-year results of the first North American trial on nerve rerouting.


METHODS
Nine subjects were enrolled in the study. Intradural lumbar to sacral nerve rerouting was performed. Subjects underwent urodynamic testing with stimulation of the cutaneous dermatome and careful neurological followup. Adverse events were closely monitored along with changes in bowel and bladder function.


RESULTS
At 1 year 7 patients (78%) had a reproducible increase in bladder pressure with stimulation of the dermatome. Two patients were able to stop catheterization and all safely stopped antimuscarinics. No patient achieved complete urinary continence. The majority of subjects reported improved bowel function. One patient was continent of stool at baseline and 4 were continent at 1 year. Of the patients 89% had variable weakness of lower extremity muscle groups at 1 month. One child had persistent foot drop and the remainder returned to baseline by 12 months.


CONCLUSIONS
At 1 year a novel reflex arc with stimulation of the appropriate dermatome was seen in the majority of subjects. Improvements in voiding and bowel function were noted. Lower extremity weakness was mostly self-limited, except in 1 subject with a persistent foot drop. More patients and longer followup are needed to assess the risk/benefit ratio of this novel procedure.
Peters
Kenneth M
KM
Department of Urology, William Beaumont Hospital, Royal Oak, Michigan, USA.
Girdler
Benjamin
B
Turzewski
Cindy
C
Trock
Gary
G
Feber
Kevin
K
Nantau
William
W
Bush
Brian
B
Gonzalez
Jose
J
Kass
Evan
E
de Benito
Juan
J
Diokno
Ananias
A
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus / Q000601:surgery*; D008297:Male; D016067:Nerve Transfer; D016135:Spinal Dysraphism / Q000150:complications*; D013126:Spinal Nerve Roots / Q000601:surgery*; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000209:etiology* / Q000601:surgery*; D055815:Young Adult