Abstract
We studied nine patients with complete thoracic spinal cord injury in order to investigate distal electrophysiologic and end organ function. Studies included motor and sensory nerve conduction velocities, spinal and cortical somatosensory evoked responses, bulbocavernosus reflex responses, cystometry and colonic compliance, motor and myoelectrical activity. These studies confirmed an intact peripheral nervous system, as well as normal nerve root, cauda equina, conus medullaris and distal spinal cord function. Cystometry demonstrated decreased bladder capacity and inability to suppress detrusor contractions. Colonic compliance was greatly reduced, compared to control subjects. While basal colonic motor and myoelectrical activity was normal, these spinal cord injury patients failed to demonstrate the postprandial increase in colonic motor and myoelectric activity seen in normal subjects. These tests allow the clinician to define and document the extent of neuronal injury distal to a transverse myelopathy and to evaluate visceral end organ function.
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References
Barrington F J F 1921 The relation of the hind-brain to micturition. Brain 44: 23.
Battle W M, Snape W J, Alavi A, et al. 1980 Colonic dysfunction in diabetes mellitus. Gastroenterology 79: 1217–1221.
Bors E 1957 Neurogenic bladder. Urological Survey 7: 177–250.
Bradley W E, Chou S, Markland C 1967 Classifying neurologic dysfunction in the urinary bladder. In: The Neurogenic Bladder, p. 139–146, Boyarsky S, Ed., Williams and Wilkins Co., Baltimore.
Bradley W E, Timm G W, Scott F B 1975 Cystometry II: Central nervous system organization of detrusor reflex. Urology 5: 578–580.
Connell A M, Frankel H, Guttmenn L 1963 The motility of the pelvic colon following complete lesions of the spinal cord. Paraplegia 1: 98–115.
Cusick J F, Myklebest J B, Larson S J, Sances A 1979 Spinal cord evaluation by cortical evoked responses. Archives of Neurology 36: 140–3.
Dick H C, Bradley W E, Scott F B, et al. 1974 Pudendal sexual reflexes: Electrophysiologic investigations. Urology 3: 376–379.
Eisen A, Elleker G 1980 Sensory nerve stimulation and evoked cerebral potentials. Neurology 30: 1097–1105.
Ertekin C, Reel F 1976 Bulbocavernosus reflex in normal men and in patients with neurogenic bladder and/or impotence. Journal of the Neurological Sciences 28: 1–15.
Glick M E, Meshkinpour H, Haldeman S, et al. 1982 Colonic dysfunction in multiple sclerosis. Gastroenterology 83: 1002–1007.
Goodgold J, Eberstein A 1972 Electrodiagnosis of Neuromuscular disease. Williams and Williams Co., Baltimore, MD.
Haldeman S, Bradley W E, Bhatia N N, et al. 1982 Pudendal evoked responses. Archives of Neurology 39: 280–283.
Haldeman S, Glick M, Bhatia N D, et al. 1982 Colonometry, cystometry and evoked responses in multiple sclerosis. Archives of Neurology 39: 698–701.
Jones S J, Small D G 1978 Spinal and sub-cortical evoked potentials following stimulation of the posterior tibial nerve in man. EEG Clinical Neurophysiology 44: 299–306.
Kuru M 1965 Nervous control of micturition. Physiological Reviews 45: 425–94.
Meshkinpour H, Nowroozi F, Glick M E 1983 Colonic compliance in patients with spinal cord injury. Archives of Physical Medicine and Rehabilitation 64: 111–112.
Raz S, Bradley W E 1979 Neuromuscular dysfunction of the lower urinary tract. In: Harrison JH, Gilles RF, Perlmutter AD, et al., eds. Cambell's Urology. Philadelphia: W. B. Saunders, Co. 1215–1272.
Rossier A, Bors E 1964 Detrusor responses to perineal and rectal stimulation in patients with spinal cord injuries. Urologa Internationalis 18: 181–190.
Rossier A B, Ott R 1974 Urinary manometry in spinal cord injury. British Journal of Urology 46: 439–448.
Scott H W, Cantrell J R 1949 Colonometrographic studies of the effects of section of the parasympathetic nerves of the colon. Bulletin of Johns Hopkins Hospital 85: 310–319.
Siroky M B, Sax D S, Krane R J 1979 Sacral signal tracing: The electrophysiology of the bulbocavernosus reflex. Journal of Urology 122: 661–664.
White J C, Verlot M C, Ehrentheil O 1940 Neurogenic disturbances of the colon and their investigation by the colonometrogram. Annals of Surgery 112: 1042.
Yalla S V, Rossier A B Fam B 1975 Synchronous cystosphincterometry in patients with spinal cord injury. Urology 6: 777–778.
Yalla S V, Rossier A B, Fam B 1976 Dyssynergic vesicourethral responses during bladder rehabilitation in spinal cord injury patients: Effects of suprapubic percussion, crede method and bethanechol chloride. Journal of Urology 115: 575–578.
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This paper was presented at the American Academy of Neurology Annual Meeting, Boston, 1984. Correspondence to: Michael E. Glick, M.D., Medical Service (111G), Veterans Administration Medical Centre, 5901 East Seventh Street, Long Beach, California 90822, U.S.A.
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Glick, M., Haldeman, S. & Meshkinpour, H. The neurovisceral and electrodiagnostic evaluation of patients with thoracic spinal cord injury. Spinal Cord 24, 129–137 (1986). https://doi.org/10.1038/sc.1986.17
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DOI: https://doi.org/10.1038/sc.1986.17