Sacral anterior root stimulation improves bowel function in subjects with spinal cord injury

Study design: Cross-sectional study. Objective: To evaluate the long-term effect of the sacral anterior root stimulator (SARS) on neurogenic bowel dysfunction in a large, well defined spinal cord injury (SCI) cohort. Setting: Department of Neuro-Urology, Bad Wildungen, Germany. Methods: Subjects undergone surgery at for SARS-SDAF (sacral deafferentation) between September 1986 and July 2011 (n = 587) answered a questionnaire. In total, 277 SARS subjects were available for the baseline (recall) and follow-up comparison. Results: Median age was 49 years (range: 19-80), time from SCI to surgery was 10 years (range: 0-49) and from surgery to follow-up 13 (range: 1-25). Of the responders 73% used SARS for bowel emptying. On visual analog scale (VAS) ranging from 0-10 (best), satisfaction with SARS was 10. Baseline and follow-up comparison showed a decline in the median VAS score 0-10 (worst) for bowel symptoms from 6 (range: 4-8) to 4 (range: 2-6), P < 0.0001; median neurogenic bowel dysfunction score from 17 (range: 11-2) to 11 (range: 9-15), P < 0.0001; median St Marks score from 4 (range: 0-7) to 4 (range: 0-5), P = 0.01; and median Cleveland constipation score from 7 (range: 6-10) to 6 (range: 4-8), P < 0.0001. Use of suppositories, digital evacuation and mini enema and subjects totally dependent on assistance during defecation were significantly lower after SARS. Conclusions: The SARS has the potential to be one of the few treatment methods targeting multiple organ dysfunctions following SCI.