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Sacral Anterior Root Stimulation (SARS) and Visceral Function Outcomes in Spinal Cord Injury–A Systematic Review of the Literature Over Four Decades
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International audience. Study design: Systematic Review Objectives: The sacral anterior root stimulator (SARS) was developed 40 years ago to restore urinary and bowel functions to individuals with spinal cord injury (SCI). Mostly used to restore lower urinary tract function, SARS implantation is coupled with sacral deafferentation to counteract the problems of chronic detrusor sphincter dyssynergia and detrusor overactivity. In this article, we systematically review 40 years of SARS implantation and assess the medical added-value of this approach in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic reviews and Meta-Analyses). We identified four axes of investigation: i) impact on visceral functions, ii) implantation safety and device reliability, iii) individuals quality of life, and iv) additional information about the procedure. Methods: Three databases were consulted: Pubmed, EBSCOhost and Pascal. 219 abstracts were screened and 38 publications were retained for analysis (1,147 implantations). Results: The SARS technique showed good clinical results (85.9% of individuals used their implant for micturition and 67.9% to ease bowel movements) and improved individual quality Guiho et al. 2 of life. Conversely, several sources of complications were reported after implantation (surgical complications, failures etc.). Conclusions: Despite promising results, a decline in implantations was observed. This decline can be linked to the complication rate, as well as to the development of new therapeutics (botulinum toxin, etc.) and directions for research (spinal cord stimulation) that may have an impact on people. Nevertheless, the lack of alternatives in the short-term suggests that the SARS implant is still relevant for the restoration of visceral functions after SCI.
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