Root reconstruction for bladder reinnervation: an experimental study in rats

Nerve transfer (or nerve crossover) is a well established technique for achieving reinnervation of a valuable sensory or motor territory by reconnection using a functional nerve of lesser value. Patients with lower spinal cord lesions causing neurogenic bladder dysfunction could theoretically benefit from such an approach for return of useful micturition. Based on the known anatomical details of the spinal nerve, a new reconstructive method was created to provide intradural ventral root transfer for pure motor-to-motor reinnervation and extradural postganglionic spinal nerve transfer for pure sensory-to-sensory reinnervation. Experimental studies in rats were performed, demonstrating the feasibility of this approach. A modified method is further suggested that would use nerve grafts for extradural approaches to pure motor and sensory transfers, without the need for extensive laminectomy and dura opening. This proposed approach is anticipated to minimize the associated morbidity and mortality with such spinal nerve reconstruction.