Lumbar anterior root stimulator: Difference between revisions
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A Lumbar Anterior Root Stimulator is a type of neuroprosthetic used in patients suffering from a spinal cord injury.[1] More specifically, the root stimulator is used in patients who have lost proper bowel function due to damaged neurons related to gastrointestinal control.[2]
Usage
The lumbar anterior root stimulator is similar in nature to Brindley's sacral anterior root stimulator. The difference in nomenclature is derived from which nerve roots on the spinal cord are being electrically stimulated.
Bowel Control
Loss of bowel control due to severed nerves in the spinal cord is one of the more common reasons for lumbar root stimulator usage. Giles Brindley initially developed for paraplegic patients with diminished or no bladder control. [2] A rhizotomy may also be performed on patients with the implant to reduce sensory reflexes which may inhibit the device's function. [3]
Treatment of Chronic Pain
Some research has been conducted in potentially using the prosthetic to help treat chronic pain as an alternative to stimulating the entire dorsal column. The stimulators are able to focus stimulation on the nerve roots of the spine and hypothetically improve the relieve of neuropathic pain signals sent through the spinal cord. The study showed some promise as all subjects indicated some degree of pain relief. [4]
Muscle Stimulation
Donaldson and Perkins theorized the ability to use lumbar root stimulation in order to restore leg function in paraplegic patients. The researchers were able to generate muscle action through the devices and were later able to display leg control in a cycling paraplegic patient. [5] [6]
Related Issues
Spinal Cord Injury
While spinal cord injury is a broad and widely-encompassing term, root stimulators can be used for many SCIs. [2] For example, certain spinal cord injuries may sever key nerves necessary to maintain bladder and bowel control. The severance is often the cause of neurogenic bowel disfunction. [7] Similarly, spinal cord injuries can potentially cause a loss of motor control in lower limbs, such as with paraplegic and tetraplegic patients. Stimulators, in turn, may be used to stimulate the muscle and treat motor control loss in order to regain function in the limbs.[5] [6]
Neurogenic Bowel Dysfunction
As mentioned previously, neurogenic bowel disfunction tends to occur after some form of spinal cord injury in which nerves important to control of sphincter contraction, bowel movements, and bladder control are severed or damaged. [7] Lumbar root stimulators have been used in order to treat bowel dysfunction by allowing the patient to regain control of both excretory muscles and organs. Regaining such motor control prevents further complications associated with NBD such as constipation, incontinence, and irritable bowel syndrome. [8]
Complications with Root Stimulators
Two major studies have been associated with issues in root stimulators. In 2004, a cervical spinal cord injury patient had severe complications. The patient experienced increased spasms and a delayed lumbar spinal fracture which required retracting the stimulator implant. Case lead Bakul Soni cited the incident as "compelling disuse" of the device. [9]
A more recent study focused on a tetraplegic SCI patient whose stimulator was infected by Pseuomana aeruginosa. As in the aforementioned case, the patient had the device removed and lost considerable function of bowel and urinary bladder control. The case identified the high risk associated with the usage of root stimulators. [10]
References
- ^ Domurath, B. "Modern neurological treatment strategies for patients with spinal cord injury". Urologe. 51 (2): 184–188. doi:10.1007/s00120-011-2780-7.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ a b c Ebert, E (2012). "Gastrointestinal Involvement in Spinal Cord Injury: a Clinical Perspective". Journal of Gastrointestinal and Liver Diseases. 21 (1): 75–82.
- ^ Castano-Botero, JC (2013). "Results of Implantation of Sacral Anterior Root Stimulator Combined with Posterior Rhizotomy in Patients with Spinal Cord Injury in Latin America". Neurourology and Urodynamics. 32: 676–7.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ Alo, KM (1999). "Lumbar and Sacral Nerve Root Stimulation (NRS) in the Treatment of Chronic Pain: A Novel Anatomic Approach and Neuro Stimulation Technique". Neuromodulation. 2 (1): 23–31.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help); Unknown parameter|month=ignored (help) - ^ a b Donaldson, N. de N. (1996). "Lumbar Root Stimulation for Restoring Leg Function: Stimulator and Measurement of Muscle Action". Artificial. 21 (3): 247–9.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help); Unknown parameter|month=ignored (help) - ^ a b Perkins, TA (2002). "Control of leg-powered paraplegic cycling using stimulation of the lumbo-sacral anterior spinal nerve roots". Artif Organs. 21 (3): 158–64.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help); Unknown parameter|month=ignored (help) - ^ a b Stiens, Steven (1997). "Neurogenic bowel dysfunction after spinal cord injury: clinical evaluation and rehabilitative management". Archives of physical medicine and rehabilitation. 78 (3): 86–102.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ Paris, G (4). "Management of Neurogenic Bowel Dysfunction". European Journal of Physical and Rehabilitation Medicine. 47 (4): 661–76.
{{cite journal}}: Check date values in:|date=and|year=/|date=mismatch (help); Unknown parameter|coauthors=ignored (|author=suggested) (help); Unknown parameter|month=ignored (help) - ^ Soni, BM (2004). "Complications of sacral anterior root stimulator implantation in a cervical spinal cord injury patient: increased spasms requiring intrathecal baclofen therapy followed by delayed fracture of lumbar spine leading to intractable spasms compelling disuse of the sacral anterior root stimulator". Spinal Cord. 42 (2): 136–8.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help); Unknown parameter|month=ignored (help) - ^ Vaidyanathan, Subramanium (21). "Infection of Brindley sacral anterior root stimulator by Pseudomonas aeruginosa requiring removal of the implant: long-term deleterious effects on bowel and urinary bladder function in a spinal cord injury patient with tetraplegia: a case report". Cases Journal. 2 (9364): 1–8. doi:10.1186/1757-1626-2-9364.
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