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Related Experiment Video

Updated: May 9, 2026

Electrophysiological Methods to Assess Peripheral Pain Block in an Anesthetized Rat
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Intraoperative Detection of a Lateralized S2 Nerve Root Conduction Block Using Hemisphincter Bulbocavernosus Reflex

Justin W Silverstein1,2, Armaan DeWal2, Gabrielle Santangelo3

  • 1Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.

The Neurodiagnostic Journal
|May 7, 2026
PubMed
Summary

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Hemisphincter bulbocavernosus reflex (BCR) monitoring can identify unilateral sacral nerve root issues during spine surgery. Maneuver-dependent loss and recovery of BCR responses indicate lateralized sacral reflex pathway dysfunction.

Area of Science:

  • Neurosurgery
  • Neurology
  • Spinal Cord Monitoring

Background:

  • Sacral reflex monitoring (BCR, EUSR) assesses bowel/bladder function during spine surgery.
  • Current methods struggle with laterality due to bilateral activation and shared circuitry.

Purpose of the Study:

  • To investigate if hemisphincter BCR recordings can detect unilateral sacral nerve root dysfunction.
  • To evaluate the utility of BCR in differentiating lateralized sacral reflex pathway issues.

Main Methods:

  • Case study of an 85-year-old male with spinal tumors and incontinence.
  • Recorded left/right external anal sphincter BCR and EUSR during tumor resection involving the left S2 nerve root.
  • Observed BCR changes during surgical manipulation near the S2 nerve root.
Keywords:
Bowel and bladder dysfunctionbulbocavernosus reflexexternal urethral sphincter reflexneuromonitoringspine surgery

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Main Results:

  • Global sacral reflex attenuation occurred during initial thecal sac manipulation, with loss of left BCR.
  • Targeted dissection near the left S2 nerve root caused isolated loss of left hemisphincter BCR.
  • Reversible loss and recovery of ipsilateral BCR correlated with S2 root retraction and release.

Conclusions:

  • Hemisphincter BCR recordings can physiologically reflect unilateral sacral nerve root dysfunction.
  • Maneuver-dependent, reversible BCR changes indicate lateralized sacral reflex pathway dysfunction, not global suppression.