title: Extradural nerve anastomosis technique for bladder reinnervation in spinal cord injury: anatomical feasibility study in human cadavers.
abstract: METHODS
  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.
  
  
  BACKGROUND
  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).
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  N/A.
authors.affiliation: *Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China †Department of Orthopedics, the People's Hospital of Suqian, Drum Tower Hospital Group of Nanjing, Jiangsu Province, China; and ‡Department of Physiology, Nanjing Medical University, Nanjing, Jiangsu Province, China.
authors.forename: Xiaoji
authors.initials: X
authors.lastname: Zhou
authors.forename: Yongtao
authors.initials: Y
authors.lastname: Liu
authors.forename: Jun
authors.initials: J
authors.lastname: Ma
authors.forename: Tao
authors.initials: T
authors.lastname: Sui
authors.forename: Yingbin
authors.initials: Y
authors.lastname: Ge
authors.forename: Xiaojian
authors.initials: X
authors.lastname: Cao
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D059925:Anatomic Landmarks; D002102:Cadaver; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D019651:Plastic Surgery Procedures; D020127:Recovery of Function; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology; D013126:Spinal Nerve Roots / Q000033:anatomy & histology* / Q000737:chemistry / Q000601:surgery*; D001743:Urinary Bladder / Q000294:innervation*; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*