Dr. Sobol Answers Your Questions

  • Patient Question:

    I'm looking for information about a procedure done in China called artificial somatic-autonomic reflex pathway for children with spina bifida. Could you tell me more about this procedure and if there are any clinical trials in the United States?


    Spina bifida is a complex condition and the procedure you are referring to requires a more in-depth explanation that is outside the scope. There is actually very little information available about this procedure. Currently there is one journal article published in the United States’ medical journals. What I do know about is, that it works. We are not doing this procedure here in the United States, for reasons that are unclear to me and other physicians who treat patients with spina bifida.
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    To briefly explain a bit of what I know, spina bifida is a condition children are born with. It is characterized by a lack of closure of the spine while the fetus is developing inside the mother. The degree of disability widely varies among these patients. Some children may be “normal” with some minimal bladder dysfunction, while other children may have malformed skeletal frames and are committed to a wheelchair for life. Other children may fall in between. Most of these children have some degree of bladder dysfunction.

    Until the 1960s or so, these children died from kidney deterioration because of the high pressures in their bladder. The medical community has made leaps and bounds to protect these children from that fate, but the result is often not the most wonderful situation. Many need to be on multiple medications, have surgeries to enlarge their bladders and either performed self-catheterization, or have a stoma with a bag on their abdomen.

    The procedure you mention, artificial somatic-autonomic reflex pathway, was published by Dr. Xiao in June 2005 in the Journal of Urology. He described a procedure originally performed on people with spinal cord injury and bladder dysfunction. He describes the procedure as a “microanastomosis of the 5th lumbar ventral root to the 3rd sacral ventral root”. This is performed to bypass the abnormal area caused by spina bifida. Basically, he is rearranging the nerves in the lower back to enhance the signals from the bladder to the brain and vice versa. The procedure takes about two hours and seems to be rather minor with minimal complications.

    As stated before, Dr. Xiao’s results are pretty good. I have had two patients that have gone to China for this procedure, but I cannot say how they have fared. It takes between eight and twelve months for the procedure to take effect. Nerves grow at a rate of 1mm, which explains why it takes so long for the procedure to take effect. Hopefully, if this procedure continues to have such great results in China, we might see it being done in the U.S. As far as I know, there are no current clinical trials in the U.S.

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Published On: September 13, 2006