Jornal de Osteoporose e Atividade Física
Acesso livre

Abstrato

Low Frequency Pelvic Nerves Stimulation: Cutaneous Vasodilation and Restoration of Bone Density in Chronic Spinal Cord Injured People

Marc Possover

Objective: We reported recently on the effect of the LION procedure for recovery some walking functions in SCI peoples. The objectives of the present studies were to determine the effect of the low-frequency stimulation of the pelvic nerves on autonomic functions.

Design: Observational case report.

Setting: Tertiary referral unit specialized in neuropelveology.

Participants: Five patients with chronic Spinal Cord Injury (SCI) who underwent a LION procedure to the pelvic somatic nerves for the recovery of standing and walking motion. Intervention: Patients underwent continuous low-frequency pelvic lumbosacral nerve neuromodulation. Main Outcome Measures: DXA scans, plethysmography and lean body mass of the lower limbs before and at follow-up two years after the LION procedure.

Results: The lower limb lean body mass increased in all five patients from 17.5 in average (± 4.45; Min 12.6-Max 23.3) directly after implantation to 23.22 (± 6.46; Min 16.1-Max 31.92), P<0.01 at 24-months follow-up, corresponding to an increase of 32% in average (± 0.033; Min 28%-Max 37%). The plethysmography examination showed in all 5 patients without any exception an instantaneous and explosive increase of Flow (ml/s) from a based line around 100 UI to >400 UI starting as soon the stimulation was turned on. Finally, the evolution of the T-score before starting with stimulation was in average -2.4 (± 0.96; Max-3, Min-1) and increased to -1.0 (± 0.57; Max-1.5, Min 0), P<0.01 at 2-years follow-up, suggesting significant improvement of bone mineral density after pelvic nerves stimulation.

Conclusions: The stimulation of pelvic sympathetic fibers should theoretically induce a peripheral vascular contraction with a reduction of the bone density of the lower limbs. However, the present study shows completely opposite results with a much higher muscle mass building, a peripheral vasodilatation as well as a significant improvement of the bones mineral density.