Functional Bladder Reconstruction Following Spinal Cord Injury via Neural Approaches

124 Pages·2014·11.992 MB·English

by  Shimin Chang, Chunlin Hou M.D. (auth.), Chunlin Hou (eds.)

Functional Bladder
Reconstruction Following
Spinal Cord Injury
vviiaa NNeeuurraall AApppprrooaacchheess
Chunlin Hou
Editor
123
Functional Bladder Reconstruction
Following Spinal Cord Injury via Neural
Approaches

Chunlin Hou
Editor
Functional Bladder
Reconstruction
Following Spinal Cord
Injury via Neural
Approaches
Editor
Chunlin Hou , M.D
Department of Orthopedic Surgery
The Second Military Medical University
Changzheng Hospital
Shanghai
People’s Republic of China
ISBN 978-94-007-7765-1 ISBN 978-94-007-7766-8 (eBook)
DOI 10.1007/978-94-007-7766-8
Springer Dordrecht Heidelberg New York London
© Springer Science+Business Media Dordrecht 2014
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Pref ace
Spinal cord injury (SCI), either traumatic or non-traumatic, is a devastating
disorder that leads to signifi cant physical, psychological and socioeconomic
burden on patient and family. Spinal cord injury often occurs in young peo-
ple, who have the prospect of an almost normal life expectancy, but a consid-
erably impaired quality of life. These patients not only experience severe
dysfunctions of voluntary movement of limbs, but also have impaired func-
tions of pelvic organs, such as the bladder and the bowel, and sexual dysfunc-
tion. In practice, one of the most distressing aspects of spinal cord injury is
not being able to regulate bladder function: urine reservoir and voiding.
Managing urinary functions in spinal cord–injured patients remains a
challenge for clinical medical workers as well as basic researchers. Generally,
the options rely on indwelling or intermittent catheterization, drugs, opera-
tions and other medical devices. Our group has performed experimental study
and clinical investigations to improve bladder function after spinal cord
injury for about 20 years, mainly focused on neural approaches. We have
received six research supports from national Natural Science Foundation of
China (NSFC). We have published more than 100 papers, in Chinese and/or
English. Our series study has also won fi rst prize from the Chinese Medical
Association.
This book is a culmination of the author’s investigation that attempt to
learn more about bladder function in spinal cord injury. After a brief review
of spinal cord injury and related anatomy, the main topic of this book is
focused on functional bladder reconstruction through neural approaches,
including somato-CNS-bladder artifi cial refl ex arc establishment through
neural anastomosis, bladder denervation through selective sacral root rhizot-
omy and sacral root stimulated micturition through electrical device implan-
tation. Our intent is to stimulate passion for further research in this fi eld and
to enable improved care and outcomes for individuals with spinal cord injury.
Shanghai, People’s Republic of China Chunlin Hou , M.D.
v

Contents
1 An Overview of Traumatic Spinal Cord Injury . . . . . . . . . . . . 1
Shimin Chang and Chunlin Hou
2 Clinical Anatomy of Cauda Equina
and Lumbosacral Nerve Root . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Ruisheng Xu and Chunlin Hou
3 Classifi cation of and Treatment Principles for Bladder
Dysfunction Caused by Spinal Cord Injury . . . . . . . . . . . . . . . 17
Mingxuan Liu and Chunlin Hou
4 Pathological Changes in the Detrusor
After Spinal Cord Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Xianyou Zheng and Chunlin Hou
5 Microstructural Study of the Detrusor Muscle
After Repair of Atonic Bladders Caused by Injury
to the Medullary Cone in Rats . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Yuelei Zhang, Jun Sheng, and Chunlin Hou
6 Selective Sacral Rhizotomy: Introducing a Simple
Intraoperative Manometric Method . . . . . . . . . . . . . . . . . . . . . 53
Chunlin Hou and Mingxuan Liu
7 Reconstruction of Bladder Innervation Below
the Level of Spinal Cord Injury for Inducing Urination
by Achilles Tendon-to-Bladder Refl ex Contractions . . . . . . . . 61
Haodong Lin, Hongbin Zhong, and Chunlin Hou
8 Reconstruction of Bladder Innervation Above the Level
of Spinal Cord Injury for Inducing Urination by
Abdomen-to-Bladder Refl ex Contractions . . . . . . . . . . . . . . . . 71
Haodong Lin, Jinwu Wang, Guibin Zhong, and Chunlin Hou
9 Reconstruction of Afferent and Efferent Nerve Pathways
of the Atonic Bladder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Haodong Lin and Chunlin Hou
10 Transfer of Normal Lumbosacral Nerve Roots
to Reinnervate Atonic Bladder. . . . . . . . . . . . . . . . . . . . . . . . . . 93
Haodong Lin, Zhen Xu, and Chunlin Hou
vii
viii Contents
11 Electrical Stimulated Micturition: Sacral Anterior Root
Stimulator + Sacral Deafferentation . . . . . . . . . . . . . . . . . . . . . 109
Shimin Chang and Chunlin Hou
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
1
An Overview of Traumatic Spinal
Cord Injury
Shimin Chang and Chunlin Hou
Spinal cord injury (SCI), either traumatic or non- 1.2 Incidence of Traumatic SCI
traumatic in origin, can lead to signifi cant physi-
cal, psychological and socioeconomic burden on A global-incident rate is estimated at 23 TSCI
patient and family. Since SCI causes extensive cases per million (179,312 cases per annum)
lifelong consequences, epidemiological data are in 2007 [ 1 ]. Regional data are available from
of fundamental importance in tracing its occur- North America (40 per million), Western
rence, deciding upon preventive strategies, and Europe (16 per million) and Australia (15 per
planning clinical resources and social services. million). Extrapolated regional data are avail-
However, there is a lack of accurate data on the able for Asia- Central (25 per million), Asia-
epidemiology of spinal cord injuries in many South (21 per million), Caribbean (19 per
countries. Although some patients of SCI are million), Latin America, Andean (19 per mil-
caused by non-traumatic reasons, such as, tumor, lion), Latin America, Central (24 per million),
tuberculosis, spine degeneration, and so on, trau- Latin America-Southern (25 per million), Sub-
matic spinal cord injury (TSCI) remains the Saharan Africa-Central (29 per million),
mainstay of epidemiologic survey of SCI. Sub-Saharan Africa-East (21 per million).
The most representative incidence statistic for
each country within WHO global regions is pre-
1.1 Prevalence of Traumatic SCI sented in Table 1 .2 , along with available etiology
data, level of injure and survival rate.
The range of reported global prevalence is Directly interpretable incidence data has not
between 280 and 4,187 per million [1 ]. The prev- changed obviously in the high income regions
alence of TSCI by country and authors of pub- such as North America, Western Europe and
lished data are presented in Table 1 .1 . Australia. Because of the economic limitations, it
is diffi cult to acquire accurate epidemiological
data for TSCI in many developing countries. But
S. Chang
it is common accepted that in the emergent coun-
Department of Orthopedic Surgery , Yangpu Hospital,
tries such in China, the incidence and prevalence
Tongji University School of Medicine , Shanghai ,
People’s Republic of China of TSCI are increased steadily. The reasons
e-mail: [email protected] include: (1) the injury cases due to high fall and
C. Hou , M.D. (*) heavy crush increased parallel to economy devel-
Department of Orthopedic Surgery , Changzheng opment; (2) as the population ages, the number of
Hospital, The Second Military Medical University ,
TSCI in elderly patients also increases; (3) as the
Fengyang Road 415 , Shanghai 200003 ,
economy develops, more patients with TSCI be
People’s Republic of China
e-mail: [email protected] recorded and registered normally, and they were
C. Hou (ed.), Functional Bladder Reconstruction Following Spinal Cord Injury via Neural Approaches, 1
DOI 10.1007/978-94-007-7766-8_1, © Springer Science+Business Media Dordrecht 2014