Impact of direct epispinal stimulation on bladder and bowel functions in pigs: A feasibility study
Impact of direct epispinal stimulation on bladder and bowel functions in pigs: A feasibility study
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DOI：
10.1002/nau.23325
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发表时间：
2018-01-01
影响因子：
2
通讯作者：
Bauchet, Luc
中科院分区：
文献类型：
--
作者：
Guiho, Thomas;Delleci, Claire;Bauchet, Luc
目的：本研究评估脊髓外（硬膜下）刺激在泌尿和肠神经系统疾病治疗中的应用潜力。在大型动物模型家猪上进行了急性实验，以开发一种新的方法，促进未来的结果和技术转移到人类。方法4头长白猪（45 ~ 50kg）经直肠和膀胱置管后，行腰骶切口、椎板切除术[l4 ~ s4]、硬脑膜切开和显微外科蛛网膜清扫术。连续进行3次电刺激：1)神经根电刺激，2)基质电极电刺激，3)小直径针电极电刺激。在整个过程中监测直肠和膀胱压力的变化，以确定诱发反应的脊髓区域，同时评估电极接触大小对测量反应幅度的影响。结果在脊髓骨髓瘤上部（即由两对连续的脊髓根分隔的脊髓段）发现了一个有趣的区域，该区域与最佳压力（直肠或膀胱）的根直接相邻。针电极也获得了显著的响应（高达40cmH(2)O）。此外，其中一只动物的肠道被触发了排空。尽管使用了较小的电极接触，但在所有的疗程中都没有观察到逼尿肌或直肠选择性反应。结论本研究首次表明，在猪的脊髓外展刺激下，逼尿肌和直肠反应明显，为进一步研究脊髓损伤患者的泌尿和直肠疾病提供了依据。
AimsThis study assesses the potential of epispinal (subdural) stimulation application in the treatment of urinary and bowel neurological disorders. Acute experiments were performed on a large animal model the domestic pig to develop a new methodology facilitating future results and technology transfers to human.MethodsAfter rectal and bladder catheterization, four Landrace pigs (45-50kg) underwent spinal cord surgery that is, lumbosacral incision, laminectomy [L4-S4], dural opening and microsurgical arachnoid dissection. Three successive electrical stimulation sessions were carried out: 1) nerve roots stimulation, 2) epispinal stimulation with a matrix electrode, 3) epispinal stimulation with a small diameter needle electrode. Changes in rectal and bladder pressures were monitored throughout the various procedures to identify spinal areas inducing responses while evaluating the influence of electrode contacts size in the measured responses amplitudes.ResultsAn interesting area was identified in the upper portion of the spinal myelomeres (ie, spinal cord segment delimited by two successive pairs of spinal roots) directly adjoining root with best pressures (either rectal or vesical). Significant responses (up to 40cmH(2)O) were also obtained with a needle electrode. Furthermore, bowel evacuation was triggered in one of the animals. Despite the use of smaller electrode contacts, no detrusor or rectum selective responses were observed in none of the sessions.ConclusionThis study showed, for the first time, that epispinal stimulation causes significant detrusor and rectal responses in pigs and allows considering further studies with the objective of treating urinary and rectal disorders in spinal cord injury patients.