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Intraoperative Recording of the Bulbocavernosus Reflex

Skinner, Stanley A.*; Vodušek, David B.

Journal of Clinical Neurophysiology: August 2014 - Volume 31 - Issue 4 - p 313–322
doi: 10.1097/WNP.0000000000000054
Invited Review

Abstract: The bulbocavernosus reflex (BCR) is mediated by the sacral somatic afferent/efferent periphery as well as the sacral cord. Unfortunately, the reflex has suffered from a partly deserved reputation as difficult to implement. However, recent stratagems have improved the test's reliability. Multipulse stimulation (enhanced by double trains as required) and exacting recording technique can yield positive and remarkably reproducible results in patients of all ages and either sex. In this review, we document a 94% baseline BCR acquisition rate among 100 consecutive cases in one institution. Acceptance and routine use of the BCR is needed to help assure optimal post-operative low sacral function in intradural and extradural surgeries at the level of conus medullaris, cauda equina, sacral plexus, and the pudendal nerve. Case studies within this review illustrate the power of the BCR to predict patient outcome or, much more importantly, reverse incipient patient injury in real time.

*Department of Neurophysiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, U.S.A.; and

University Medical Centre, Ljubtjana, Slovenia.

Address correspondence and reprint requests to Stanley A. Skinner, MD, Department of Neurophysiology, Abbott Northwestern Hospital, 800 East 28th Street, Suite 304, Minneapolis, MN 55407, U.S.A.; e-mail:

© 2014 by the American Clinical Neurophysiology Society