An international team of specialists has conducted research at the IMQ Zorrotzaurre Clinic in Bilbao (Vizcaya) that has allowed for the identification and description of a new neurophysiological reflex in the human spinal cord, demonstrating that its different segments maintain a functional interconnection.
The work, led by the neurophysiologist of this center, Dr. Patricia Colmenárez, has been developed in the context of routine clinical practice, in the operating room and with patients under general anesthesia. The results, published in the specialized journal 'Clinical Neurophysiology', have allowed for the characterization of this intersegmental reflex of the pudendal nerve (IPR, for its acronym in English).
"This finding allows for a better understanding of the functioning of the spinal cord, something that can be critical in the context of spinal surgeries," stated Colmenárez, who is the author of this research along with the member of the Araba University Hospital, Berenice Murià, and the members of Mount Sinai West Hospital in New York (United States), María J. Téllez and Sedat Ulkatan.
The specialist from the IMQ Zorrotzaurre Clinic, recently recognized at the X Annual Congress of the Spanish Association of Intraoperative Neurophysiological Monitoring (AMINE), has specified that the pudendal is a nerve located in the pelvic area, responsible for the innervation of the external genitals of men and women, as well as the sphincters of the urinary bladder and the external anal sphincter muscle.
Furthermore, she has recalled that a reflex is an automatic and involuntary reaction of the nervous system to a specific stimulus from the environment, to emphasize that the one described offers "the possibility of evaluating the connectivity between the segments of the sacral area (lower part of the spine), lumbar area, and thoracic area of the spinal cord, in real time and during the surgery itself."
Increased safety in spinal surgery
According to her, this type of analysis "increases patient safety in surgeries that affect this nerve and, by extension, the organs it reaches." Therefore, she believes that "this advancement in knowledge can have essential importance for the preservation of urogenital, anal, and sexual function."
Regarding the origin of the investigation, he explained that "in certain patients, by stimulating the pudendal nerve during surgery, muscular responses appeared that could not be explained solely by the classical sacral reflex circuits." "The responses appeared in abdominal muscles and structures distant from the sacral segment, suggesting a much broader spinal communication than what was traditionally described," he clarified, emphasizing that, "at first, it seemed like a physiological curiosity" but, "then, it started to repeat."
In light of this repetition of findings, the Neurophysiology Department of the IMQ Zorrotzaurre Clinic decided to simultaneously record, during spinal interventions, the activity of different muscle groups. "What we observed was consistent: there was a reproducible pattern of reflex responses involving complex intersegmental spinal networks," Colmenárez stated.
In his opinion, this discovery "opens a new line of research in an important field of Medicine, such as intraoperative neurophysiology, which is applied daily in operating rooms around the world." Thanks to this, there is already "a better functional evaluation of the spinal cord during spinal surgeries, greater sensitivity in surgeries for spinal tumors and complex deformities, a more global and complete monitoring of spinal nerve circuits, a new technique to add to the classical monitoring during surgeries and, most importantly, a pathway for the development of new diagnostic and therapeutic applications for patients," he concluded.