Treatment and Prevention of Bacterial Translocation and Endotoxemia With Stimulation of the Sacral Nerve Root in a Rabbit Model of Spinal Cord Injury

Study Design. Normal rabbits and paraplegic rabbits were subjected to an acute, complete spinal cord injury (SCI) event. In a subset of paraplegic rabbits, an electrode was implanted to provide electrical stimulation of the sacral 3 (S3) nerve root. Objective. To investigate the effect of sacral nerve root stimulation on the treatment and prevention of bacterial translocation from the gut and endotoxemia in rabbits after an acute and complete SCI. Summary of Background Data. It has been demonstrated that bacterial translocation and endotoxemia were complications after a SCI-induced paraplegia due to intestinal tract dysfunction. Sacral nerve root stimulation has been shown to improve intestinal tract motion and defecation, however, the treatment and prevention of bacterial translocation originating in the gut with sacral nerve root stimulation has not been confirmed or tested after an acute, complete SCI. Methods. A model of paraplegia was established with injury of the spinal cord of rabbits. The experimental group (EG) included paraplegic rabbits that received electrical stimulation of the S3 nerve root. The paraplegic control group (CG) (paraplegic rabbits) and the normal control group (uninjured rabbits) did not receive electrical stimulation. Under aseptic conditions, samples of blood, liver, spleen, and mesenteric lymph nodes were collected at 24, 48, and 72 hours after SCI. Samples were analyzed with bacterial cultures and endotoxin assays. The morphology and ultrastructure of the small intestine was also analyzed. Results. Bacterial translocation and endotoxemia were detected in both the paraplegic CG and the EG. In paraplegic rabbits, S3 nerve root stimulation improved defecation (F = 19.974, P = 0.000), reduced the levels of endotoxins present in the blood to normal levels (F = 16.786, P = 0.000), and reduced the incidence of bacterial translocation from the gut (n = 18, P < 0.01). In contrast, the endotoxin content and incidence rate of bacterial translocation in the gut for the paraplegic CG following SCI increased. Pathologic changes became more apparent and remarkable with the constipation and endotoxemia aggravating in the CG, however, these conditions were not apparent in the EG. Conclusion. After SCI, S3 nerve root stimulation improved intestinal tract motion and defecation in paraplegic rabbits. Furthermore, the incidence rate of bacterial translocation from the gut and endotoxemia were reduced. Thus, the risk systemic inflammatory response syndrome and multiple organ dysfunction syndrome can also be reduced.