Sacral Deafferentation and Anterior Root Stimulation: The Brindley Procedure

Abstract

After years of research and experimenting, neurostimulation of the sacral anterior roots (S.A.R.S) in humans, was introduced by Giles S. Brindley from London in the early 1970s. He aimed at restoring evacuation of urine in patients with neurogenic bladder dysfunction due to spinal cord injury by electrical stimulation of the sacral nerves (S2–S4). By selective stimulation of these sacral roots, micturition was induced by detrusor contraction. Together with the company Finetech Ltd. a silicon embedded implant was developed that consisted of an array of electrodes, connected to a subcutaneous receiver that could be stimulated by electromagnetic transmission from an external transmitter [1, 2]. The first implant was performed in a human in 1976 [3]. However, at that moment the treatment did not address the problem of detrusor contractions and incontinence between episodes of micturition. Later, Brindley together with D. Sauerwein from Bad Wildungen combined the implantation of the electrodes with posterior rhizotomies at the S2–S4 levels. These rhizotomies result in a deafferentation as the sacral reflex arch (SDAF) is interrupted hence abolishing the reflex contractions of the bladder at low filling. Hence urinary incontinence is abolished and bladder capacity and compliance increase significantly. The combination of sacral anterior root stimulation using the Brindley stimulator and posterior rhizotomy has become known as the Brindley procedure [3, 4].