Lookup NU author(s): Dr Thomas Guiho
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©AANS 2019, except where prohibited by US copyright law OBJECTIVE Spinal cord injuries (SCIs) result in loss of movement and sensory feedback, but also organ dysfunction. Nearly all patients with complete SCI lose bladder control and are prone to kidney failure if intermittent catheterization is not performed. Electrical stimulation of sacral spinal roots was initially considered to be a promising approach for restoring continence and micturition control, but many patients are discouraged by the need for surgical deafferentation as it could lead to a loss of sensory functions and reflexes. Nevertheless, recent research findings highlight the renewed interest in spinal cord stimulation (SCS). It is thought that synergic recruitment of spinal fibers could be achieved by stimulating the spinal neural networks involved in regulating physiological processes. Paradoxically, most of these recent studies focused on locomotor issues, while few addressed visceral dysfunction. This could at least partially be attributed to the lack of methodological tools. In this study, the authors aim to fill this gap by presenting a comprehensive method for investigating the potential of SCS to restore visceral functions in domestic pigs, a large-animal model considered to be a close approximation to humans. METHODS This methodology was tested in 7 female pigs (Landrace pig breed, 45–60 kg, 4 months old) during acute experiments. A combination of morphine and propofol was used for anesthesia when transurethral catheterization and lumbosacral laminectomy (L4–S4) were performed. At the end of the operation, spinal root stimulation (L6–S5) and urodynamic recordings were performed to compare the evoked responses with those observed intraoperatively in humans. RESULTS Nervous excitability was preserved despite long-term anesthesia (mean 8.43 ± 1.5 hours). Transurethral catheterization and conventional laminectomy were possible while motor responses (gluteus muscle monitoring) were unaffected throughout the procedure. Consistent detrusor (approximately 25 cm H 2 O) and sphincter responses were obtained, whereas spinal root stimulation elicited detrusor and external urethral sphincter co-contractions similar to those observed intraoperatively in humans. CONCLUSIONS Pigs represent an ideal model for SCS studies aimed at visceral function investigation and restoration because of the close similarities between female domestic pigs and humans, both in terms of anatomical structure and experimental techniques implemented. This article provides methodological keys for conducting experiments with equipment routinely used in clinical practice.
Author(s): Guiho T, Azevedo-Coste C, Guiraud D, Delleci C, Capon G, Delgado-Piccoli N, Bauchet L, Vignes J-R
Publication type: Article
Publication status: Published
Journal: Journal of Neurosurgery: Spine
Print publication date: 01/05/2019
Online publication date: 15/02/2019
Acceptance date: 02/11/2018
ISSN (print): 1547-5654
ISSN (electronic): 1547-5646
Publisher: American Association of Neurological Surgeons
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