The artificial somato-autonomic reflex arch does not improve bowel function in subjects with spinal cord injury.
METHODS
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.


METHODS
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.
Pelvic floor unit, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.|Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.
M M
MM
Rasmussen
Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
K
K
Krogh
Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.
D
D
Clemmensen
Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.
H
H
Tankisi
Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.
A
A
Fuglsang-Frederiksen
Department of Urology, Aarhus University Hospital, Aarhus, Denmark.
Y
Y
Rawashdeh
Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Aarhus, Denmark.
H
H
Bluhme
Pelvic floor unit, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
P
P
Christensen
D001003:Anal Canal / Q000503:physiopathology; D000714:Anastomosis, Surgical / Q000379:methods; D003106:Colon / Q000000981:diagnostic imaging / Q000503:physiopathology; D003248:Constipation / Q000209:etiology / Q000503:physiopathology; D003287:Contrast Media; D003672:Defecation / Q000502:physiology; D003718:Denmark; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D055496:Neurogenic Bowel / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D009460:Neurologic Examination; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D010865:Pilot Projects; D011877:Radionuclide Imaging; D012007:Rectum / Q000000981:diagnostic imaging / Q000503:physiopathology; D012018:Reflex / Q000502:physiology*; D013119:Spinal Cord Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D013126:Spinal Nerve Roots / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome
D003287:Contrast Media