TWO-YEAR OUTCOMES WITH LUMBAR TO SACRAL NERVE
REROUTING IN SPINA BIFIDA
Kevin Feber*, Damon Dyche, Benjamin Girdler, Cindy Turzewski,
Gary Trock, William Nantau, Evan Kass, Kenneth Peters, Royal
Oak, MI
INTRODUCTION AND OBJECTIVES: Restoring bladder and
bowel function in spina bifida by the creation of a skin-CNS-bladder
reflex arc via lumbar to sacral nerve rerouting has a reported success
rate of 87% in China. The purpose of this abstract is to report the 2 year
analysis of the first North American trial on nerve rerouting.
METHODS: Nine subjects were enrolled in this trial. Intradural
lumbar to sacral nerve rerouting was performed through a laminectomy.
Subjects underwent urodynamic testing (UDT) with stimulation of
the cutaneous dermatome and careful neurological follow-up. Adverse
events were closely monitored along with changes in bowel and bladder
function.
RESULTS: By 24 months, 7/9 patients had a lumbar-sacral
nerve reflex with stimulation of the appropriate dermatome, 8 of 9
patients were voiding to some degree and 5/9 patients were emptying
50% of bladder volume. Bladder compliance markedly improved in
50% of patients that had poor baseline compliance (10 ml/cm H20). 8
of 9 patients were safely off antimuscarinics and 50% had complete
resolution of involuntary detrusor contractions. Renal function and
kidney ultrasounds remained stable. At 24 months follow up, all patients
had returned to their baseline mobility except for one with
persistent foot drop. No patients had worsening of urinary function and
7/9 (78%) reported improvement. No patients had worsening of bowel
function and 6/9 (66%) reported improvement. Where as only one
patient (11%) was continent of stool at baseline, by 24 months 5/9
(56%)were continent. Quality of life was improved in 6/9 (66%) of
patients and worse in 1 (foot drop). The majority, 7/9 (78%) would
undergo the procedure again.
CONCLUSIONS: At 24 months, successful nerve rerouting was
confirmed in 7/9 (78%) of patients having a skin to bladder reflex. The
majority of patients had significant improvement of urinary and bowel
function. 8/9 patients were off anticholinergics and able to void between
catheterizations, but the majority still had occasional stress urinary
incontinence. Future studies with strict inclusion criteria are necessary
to identify the best potential outcomes for spina bifida patients undergoing
lumbar to sacral nerve rerouting.
Source of Funding: From the Ministrelli Program for Urology
Research and Education (MPURE)