POSTERIOR SACRAL RHIZOTOMY AND INTRADURAL ANTERIOR SACRAL ROOT STIMULATION FOR TREATMENT OF THE SPASTIC BLADDER IN SPINAL-CORD INJURED PATIENTS

Purpose: The efficacy of intradural sacral posterior rhizotomy combine d with intradural sacral anterior root stimulation in the treatment of the neurogenic hyperreflexic bladder was evaluated. Materials and Met hods: We reviewed 10 spinal cord injured patients who underwent surger y between September 1990 and February 1994. Bladder function was compa red preoperatively and postoperatively. Intraoperative data on electro stimulation of the detrusor and striated muscles were analyzed. Result s: Stimulation of the anterior S3 and S4 roots was mostly used to empt y the bladder (7 of 10 cases). Preoperative reflex incontinence disapp eared in all patients postoperatively. Mean postoperative bladder capa city increases and mean postoperative post-void residual decreases wer e at least 340 mi. (p <0.01) and 140 mi. (p <0.01), respectively. Preo perative vesicorenal reflux disappeared in 2 and improved in 3 cases a fter sacral deafferentation. Autonomic hyperreflexia, which was presen t preoperatively in 6 patients, never disappeared but significantly im proved after deafferentation. No major complications were noted postop eratively. Conclusions: Intradural sacral posterior rhizotomy combined with intradural sacral anterior root stimulation is a valuable method to treat the hyperreflexic bladder with incontinence resistant to con servative therapy in spinal cord injured patients. Autonomic hyperrefl exia was decreased but not suppressed by posterior sacral rhizotomy.