Anorectal motility responses to selective stimulation of the ventral sacral nerve roots in an experimental model
Background: Control of defaecation and continence may be lost in patients with spinal cord injury. Electrical stimulation of sacral nerve roots to promote defaecation simultaneously activates both the rectum and the external anal sphincter (EAS), and may actually obstruct defaecation. The aim of thi...
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| Published in | British journal of surgery Vol. 92; no. 12; pp. 1513 - 1519 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Chichester, UK
John Wiley & Sons, Ltd
01.12.2005
Wiley |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Background:
Control of defaecation and continence may be lost in patients with spinal cord injury. Electrical stimulation of sacral nerve roots to promote defaecation simultaneously activates both the rectum and the external anal sphincter (EAS), and may actually obstruct defaecation. The aim of this study was to investigate whether the EAS could be blocked selectively by selective stimulation of the ventral sacral nerve roots, and whether activation of the rectum without activation of the EAS could be obtained by stimulation of the ventral sacral nerve roots.
Methods:
Selective electrical stimulation was performed using anodal blocking, a tripolar cuff electrode and monophasic rectangular current pulses applied to the sacral nerve roots in nine Göttingen minipigs.
Results:
Simultaneous responses in the rectum and the anal canal were observed in five animals, whereas only anal responses were noted in four. Variations in cross‐sectional area and an increase in rectal pressure seemed to facilitate defaecation. Without blocking, the increase in anal canal pressure was 16–45 cmH2O. With blocking, this increase was abolished in seven and reduced to 3–6 cmH2O in two animals.
Conclusion:
Selective activation of the rectum is possible using an anodal block of somatic motor fibres. This technique holds promise in further development of electro‐defaecation. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Animal model for sacral nerve stimulation |
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| AbstractList | Background:: Control of defaecation and continence may be lost in patients with spinal cord injury. Electrical stimulation of sacral nerve roots to promote defaecation simultaneously activates both the rectum and the external anal sphincter (EAS), and may actually obstruct defaecation. The aim of this study was to investigate whether the EAS could be blocked selectively by selective stimulation of the ventral sacral nerve roots, and whether activation of the rectum without activation of the EAS could be obtained by stimulation of the ventral sacral nerve roots. Methods:: Selective electrical stimulation was performed using anodal blocking, a tripolar cuff electrode and monophasic rectangular current pulses applied to the sacral nerve roots in nine Goettingen minipigs. Results:: Simultaneous responses in the rectum and the anal canal were observed in five animals, whereas only anal responses were noted in four. Variations in cross-sectional area and an increase in rectal pressure seemed to facilitate defaecation. Without blocking, the increase in anal canal pressure was 16-45 cmH sub(2)O. With blocking, this increase was abolished in seven and reduced to 3-6 cmH sub(2)O in two animals. Conclusion:: Selective activation of the rectum is possible using an anodal block of somatic motor fibres. This technique holds promise in further development of electro-defaecation. Background: Control of defaecation and continence may be lost in patients with spinal cord injury. Electrical stimulation of sacral nerve roots to promote defaecation simultaneously activates both the rectum and the external anal sphincter (EAS), and may actually obstruct defaecation. The aim of this study was to investigate whether the EAS could be blocked selectively by selective stimulation of the ventral sacral nerve roots, and whether activation of the rectum without activation of the EAS could be obtained by stimulation of the ventral sacral nerve roots. Methods: Selective electrical stimulation was performed using anodal blocking, a tripolar cuff electrode and monophasic rectangular current pulses applied to the sacral nerve roots in nine Göttingen minipigs. Results: Simultaneous responses in the rectum and the anal canal were observed in five animals, whereas only anal responses were noted in four. Variations in cross‐sectional area and an increase in rectal pressure seemed to facilitate defaecation. Without blocking, the increase in anal canal pressure was 16–45 cmH2O. With blocking, this increase was abolished in seven and reduced to 3–6 cmH2O in two animals. Conclusion: Selective activation of the rectum is possible using an anodal block of somatic motor fibres. This technique holds promise in further development of electro‐defaecation. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Animal model for sacral nerve stimulation Control of defaecation and continence may be lost in patients with spinal cord injury. Electrical stimulation of sacral nerve roots to promote defaecation simultaneously activates both the rectum and the external anal sphincter (EAS), and may actually obstruct defaecation. The aim of this study was to investigate whether the EAS could be blocked selectively by selective stimulation of the ventral sacral nerve roots, and whether activation of the rectum without activation of the EAS could be obtained by stimulation of the ventral sacral nerve roots. Selective electrical stimulation was performed using anodal blocking, a tripolar cuff electrode and monophasic rectangular current pulses applied to the sacral nerve roots in nine Göttingen minipigs. Simultaneous responses in the rectum and the anal canal were observed in five animals, whereas only anal responses were noted in four. Variations in cross-sectional area and an increase in rectal pressure seemed to facilitate defaecation. Without blocking, the increase in anal canal pressure was 16-45 cmH(2)O. With blocking, this increase was abolished in seven and reduced to 3-6 cmH(2)O in two animals. Selective activation of the rectum is possible using an anodal block of somatic motor fibres. This technique holds promise in further development of electro-defaecation. BACKGROUNDControl of defaecation and continence may be lost in patients with spinal cord injury. Electrical stimulation of sacral nerve roots to promote defaecation simultaneously activates both the rectum and the external anal sphincter (EAS), and may actually obstruct defaecation. The aim of this study was to investigate whether the EAS could be blocked selectively by selective stimulation of the ventral sacral nerve roots, and whether activation of the rectum without activation of the EAS could be obtained by stimulation of the ventral sacral nerve roots.METHODSSelective electrical stimulation was performed using anodal blocking, a tripolar cuff electrode and monophasic rectangular current pulses applied to the sacral nerve roots in nine Göttingen minipigs.RESULTSSimultaneous responses in the rectum and the anal canal were observed in five animals, whereas only anal responses were noted in four. Variations in cross-sectional area and an increase in rectal pressure seemed to facilitate defaecation. Without blocking, the increase in anal canal pressure was 16-45 cmH(2)O. With blocking, this increase was abolished in seven and reduced to 3-6 cmH(2)O in two animals.CONCLUSIONSelective activation of the rectum is possible using an anodal block of somatic motor fibres. This technique holds promise in further development of electro-defaecation. |
| Author | Buntzen, S. Djurhuus, J. C. Vukovic, A. Rijkhoff, N. J. M. Laurberg, S. Andersen, I. S. |
| Author_xml | – sequence: 1 givenname: I. S. surname: Andersen fullname: Andersen, I. S. email: inges@iekf.au.dk organization: Institute of Experimental Clinical Research, Aarhus University Hospital, Aarhus, Denmark – sequence: 2 givenname: N. J. M. surname: Rijkhoff fullname: Rijkhoff, N. J. M. organization: Centre for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark – sequence: 3 givenname: A. surname: Vukovic fullname: Vukovic, A. organization: Centre for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark – sequence: 4 givenname: S. surname: Buntzen fullname: Buntzen, S. organization: Surgical Research Unit, Department of Surgery L, Section AAS, Aarhus University Hospital, Aarhus, Denmark – sequence: 5 givenname: J. C. surname: Djurhuus fullname: Djurhuus, J. C. organization: Institute of Experimental Clinical Research, Aarhus University Hospital, Aarhus, Denmark – sequence: 6 givenname: S. surname: Laurberg fullname: Laurberg, S. organization: Surgical Research Unit, Department of Surgery L, Section AAS, Aarhus University Hospital, Aarhus, Denmark |
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| Copyright | Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. 2006 INIST-CNRS Copyright (c) 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. |
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| Keywords | Medicine Motility Treatment Surgery Stimulation Anorectal Models Experimental study Sacral root Sacral nerve |
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| References_xml | – volume: 73 start-page: 478 year: 1986 end-page: 482 article-title: Differential effects of sacral anterior root stimulation on anal sphincter and colorectal motility in spinally injured man publication-title: Br J Surg – volume: 300 start-page: 1494 year: 1990 end-page: 1497 article-title: Control of defecation in patients with spinal injuries by stimulation of sacral anterior nerve roots publication-title: BMJ – volume: 82 start-page: 1512 year: 2001 end-page: 1519 article-title: An implantable neuroprosthesis for restoring bladder and bowel control to patients with spinal cord injuries: a multicenter trial publication-title: Arch Phys Med Rehabil – volume: 2 start-page: 92 year: 1994 end-page: 99 article-title: Acute animal studies on the use of anodal block to reduce urethral resistance in sacral root stimulation publication-title: IEEE Trans Rehab Eng – volume: 52 start-page: 151 year: 1995 end-page: 180 article-title: Detrusor–sphincteric dyssynergia in paraplegics compared with the synergia in a brain‐dead human by using the single‐fibre action potential recording method publication-title: J Auton Nerv Syst – volume: 16 start-page: 342 year: 1998 end-page: 349 article-title: Implantation of anterior sacral root stimulators combined with posterior sacral rhizotomy in spinal injury patients publication-title: World J Urol – volume: 16 start-page: 99 year: 2004 end-page: 105 article-title: New probe for the measurement of dynamic changes in the rectum publication-title: Neurogastroenterol Motil – volume: 157 start-page: 1504 year: 1997 end-page: 1508 article-title: Selective detrusor activation by electrical sacral nerve root stimulation in spinal cord injury publication-title: J Urol – volume: 33 start-page: 762 year: 1995 end-page: 768 article-title: Modelling selective activation of small myelinated nerve fibres using a monopolar point electrode publication-title: Med Biol Eng Comput – volume: 38 start-page: 301 year: 2000 end-page: 308 article-title: Clinical evaluation and management of neurogenic bowel after spinal cord injury publication-title: Spinal Cord – volume: 41 start-page: 413 year: 1994 end-page: 424 article-title: Selective stimulation of sacral nerve roots for bladder control: a study by computer modeling publication-title: IEEE Trans Biomed Eng – volume: 21 start-page: 223 year: 1997 end-page: 226 article-title: Selective detrusor activation by electrical stimulation of the human sacral nerve roots publication-title: Artif Organs – volume: 38 start-page: 573 year: 2000 end-page: 580 article-title: Anorectal physiology following spinal cord injury publication-title: Spinal Cord – volume: 66 start-page: 273 year: 1974 end-page: 280 article-title: Functional importance of extrinsic parasympathetic innervation to the distal colon and rectum in man publication-title: Gastroenterology – volume: 28 start-page: 373 year: 1981 end-page: 378 article-title: A technique for collision block of peripheral nerve: single stimulus analysis publication-title: IEEE Trans Biomed Eng – start-page: 359 year: 1996 end-page: 360 – volume: 43 start-page: 1083 year: 1980 end-page: 1090 article-title: A technique for anodally blocking large nerve fibres through chronically implanted electrodes publication-title: J Neurol Neurosurg Psychiatry – volume: 49 start-page: 1104 year: 1986 end-page: 1114 article-title: Sacral anterior root stimulators for bladder control in paraplegia: the first 50 cases publication-title: J Neurol Neurosurg Psychiatry – volume: 38 start-page: 168 year: 1991 end-page: 174 article-title: Selective activation of small motor axons by quasi‐trapezoidal current pulses publication-title: IEEE Trans Biomed Eng – volume: 16 start-page: 811 year: 1992 end-page: 819 article-title: Autonomic influences on colorectal motility and pelvic surgery publication-title: World J Surg – volume: 36 start-page: 847 year: 1998 end-page: 853 article-title: The effect of electrical stimulation on colonic transit following spinal cord injury in cats publication-title: Spinal Cord – volume: 9 start-page: 61 issue: Suppl A year: 1988 end-page: 64 article-title: The four‐electrode impedance technique: a method for investigation of compliance in luminal organs publication-title: Clin Phys Physiol Meas – volume: 9 start-page: 332 year: 1991 end-page: 340 article-title: Impedance planimetry: a new approach to biomechanical intestinal wall properties publication-title: Dig Dis – volume: 40 start-page: 1233 year: 1997 end-page: 1239 article-title: Colorectal function in patients with spinal cord lesions publication-title: Dis Colon Rectum – volume: 33 start-page: 666 year: 1990 end-page: 673 article-title: Neuroanatomy of the striated muscular anal continence mechanism. Implications for the use of neurostimulation publication-title: Dis Colon Rectum – volume: 21 start-page: 55 year: 2002 end-page: 64 article-title: Selective suppression of sphincter activation during sacral anterior nerve root stimulation publication-title: Neurourol Urodyn – volume: 32 start-page: 795 year: 1994 end-page: 805 article-title: The first 500 patients with sacral anterior root stimulator implants: general description publication-title: Paraplegia – volume: 12 start-page: 497 year: 1993 end-page: 503 article-title: Worldwide experience with the Finetech–Brindley sacral anterior root stimulator publication-title: Neurourol Urodyn |
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Control of defaecation and continence may be lost in patients with spinal cord injury. Electrical stimulation of sacral nerve roots to promote... Control of defaecation and continence may be lost in patients with spinal cord injury. Electrical stimulation of sacral nerve roots to promote defaecation... Background:: Control of defaecation and continence may be lost in patients with spinal cord injury. Electrical stimulation of sacral nerve roots to promote... BACKGROUNDControl of defaecation and continence may be lost in patients with spinal cord injury. Electrical stimulation of sacral nerve roots to promote... |
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| SubjectTerms | Anal Canal - physiology Animals Biological and medical sciences Electric Impedance Electric Stimulation - methods Gastrointestinal Motility - physiology General aspects Medical sciences Models, Biological Pressure Sacrum - innervation Spinal Nerve Roots - physiology Swine Swine, Miniature |
| Title | Anorectal motility responses to selective stimulation of the ventral sacral nerve roots in an experimental model |
| URI | https://api.istex.fr/ark:/67375/WNG-PLLT72HL-H/fulltext.pdf https://onlinelibrary.wiley.com/doi/abs/10.1002%2Fbjs.4987 https://www.ncbi.nlm.nih.gov/pubmed/16273528 https://search.proquest.com/docview/19773961 https://search.proquest.com/docview/68846643 |
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