• World Neurosurg · Jan 2022

    Review

    Sacral Anterior Root Stimulation (SARS) and visceral function outcomes in spinal cord injury - a systematic review of literature over four decades.

    • Thomas Guiho, Christine Azevedo-Coste, Luc Bauchet, Claire Delleci, Jean-Rodolphe Vignes, David Guiraud, and Charles Fattal.
    • INRIA, University of Montpellier, CNRS, Montpellier, Occitanie, France; Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, Tyne and Wear, United Kingdom. Electronic address: thomas.guiho@inria.fr.
    • World Neurosurg. 2022 Jan 1; 157: 218-232.e14.

    ObjectiveSacral anterior root stimulation (SARS) was developed 40 years ago to restore urinary and bowel functions to individuals with spinal cord injury. Mostly used to restore lower urinary tract function, SARS implantation is coupled with sacral deafferentation to counteract the problems of chronic detrusor sphincter dyssynergia and detrusor overactivity. In this article, we systematically review 40 years of SARS implantation and assess the medical added value of this approach in accordance with the PRISMA guidelines. We identified 4 axes of investigation: 1) impact on visceral functions, 2) implantation safety and device reliability, 3) individuals' quality of life, and 4) additional information about the procedure.MethodsA systematic review was performed. Three databases were consulted: PubMed, EBSCOhost, and Pascal. A total of 219 abstracts were screened and 38 articles were retained for analysis (1147 implantations).ResultsThe SARS technique showed good clinical results (85.9% of individuals used their implant for micturition and 67.9% to ease bowel movements) and improved individual quality of life. Conversely, several sources of complications were reported after implantation (e.g., surgical complications and failure).ConclusionsDespite promising results, a decline in implantations was observed. This decline can be linked to the complication rate, as well as to the development of new therapeutics (e.g., botulinum toxin) and directions for research (spinal cord stimulation) that may have an impact on people. Nevertheless, the lack of alternatives in the short-term suggests that the SARS implant is still relevant for the restoration of visceral functions after spinal cord injury.Copyright © 2021 Elsevier Inc. All rights reserved.

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