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Intraoperative study of afferent and efferent connections in the upper lumbar spinal cord - Part 2: genitoinguinal reflex.

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Τίτλος: Intraoperative study of afferent and efferent connections in the upper lumbar spinal cord - Part 2: genitoinguinal reflex.
Συγγραφείς: de Melo DLM; Department of Clinical Neurophysiology. SARAH Network of Rehabilitation Hospitals, Brasília, DF, Brazil. Electronic address: denisemed@gmail.com., Oliveira DRDCAB; Department of Clinical Neurophysiology. SARAH Network of Rehabilitation Hospitals, Brasília, DF, Brazil., Madureira PLDS; Department of Clinical Neurophysiology. SARAH Network of Rehabilitation Hospitals, Brasília, DF, Brazil., Ventura FD; Department of Clinical Neurophysiology. SARAH Network of Rehabilitation Hospitals, Brasília, DF, Brazil., Dominici M; Department of Clinical Neurophysiology. SARAH Network of Rehabilitation Hospitals, Brasília, DF, Brazil., Pinheiro DS; Department of Clinical Neurophysiology. Federal University of São Paulo, São Paulo, SP, Brazil., Simon MV; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
Πηγή: Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology [Clin Neurophysiol] 2026 Sep; Vol. 189, pp. 2111888. Date of Electronic Publication: 2026 Apr 07.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Elsevier Country of Publication: Netherlands NLM ID: 100883319 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1872-8952 (Electronic) Linking ISSN: 13882457 NLM ISO Abbreviation: Clin Neurophysiol Subsets: MEDLINE
Imprint Name(s): Original Publication: Amsterdam : Elsevier, c1999-
Ιατρικοί όροι (MeSH): Reflex*/physiology , Spinal Cord*/physiology , Intraoperative Neurophysiological Monitoring*/methods , Efferent Pathways*/physiology , Afferent Pathways*/physiology, Electric Stimulation/methods ; Muscle, Skeletal/physiology ; Muscle, Skeletal/innervation ; Humans ; Female ; Male ; Adult ; Middle Aged ; Aged
Περίληψη: Objective: To describe spinal reflex responses mediated by the upper lumbar spinal cord in humans and observed intraoperatively under general anesthesia.
Methods: Thirty-one participants undergoing spinal surgery were enrolled. Reflex responses were recorded from the iliopsoas, adductor magnus, and rectus femoris muscles following electrical stimulation of the cutaneous territory innervated by the genitofemoral and ilioinguinal nerves using a multipulse train paradigm.
Results: Reflex responses were obtained in the iliopsoas, adductor magnus, and rectus femoris muscles, with distinct recordability rates and neurophysiological characteristics. The most robust and consistently reproducible responses were recorded in the iliopsoas muscle; this response pattern was termed the Genitoinguinal Reflex (GNIR).
Conclusions: GNIR components can be reliably elicited in humans under general anesthesia. Stimulation frequently produced proximal thigh movement, which may interfere with surgery and therefore necessitates intermittent application when safe.
Significance: The identification of these reflex responses expands current knowledge of human spinal cord circuitry. Moreover, GNIR recording may represent a useful intraoperative neurophysiological technique for monitoring the integrity of the upper lumbar spinal cord, L1-L2 nerve roots, and the genitofemoral, ilioinguinal, and femoral nerves.
(Copyright © 2026 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Contributed Indexing: Keywords: Femoral nerve; Genitofemoral nerve; Genitoinguinal reflex; Ilioinguinal nerve; Intraoperative neurophysiological monitoring; Spinal cord reflexes
Entry Date(s): Date Created: 20260412 Date Completed: 20260612 Latest Revision: 20260612
Update Code: 20260612
DOI: 10.1016/j.clinph.2026.2111888
PMID: 41966867
Βάση Δεδομένων: MEDLINE
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  Data: Intraoperative study of afferent and efferent connections in the upper lumbar spinal cord - Part 2: genitoinguinal reflex.
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  Data: <searchLink fieldCode="AU" term="%22de+Melo+DLM%22">de Melo DLM</searchLink>; Department of Clinical Neurophysiology. SARAH Network of Rehabilitation Hospitals, Brasília, DF, Brazil. Electronic address: denisemed@gmail.com.<br /><searchLink fieldCode="AU" term="%22Oliveira+DRDCAB%22">Oliveira DRDCAB</searchLink>; Department of Clinical Neurophysiology. SARAH Network of Rehabilitation Hospitals, Brasília, DF, Brazil.<br /><searchLink fieldCode="AU" term="%22Madureira+PLDS%22">Madureira PLDS</searchLink>; Department of Clinical Neurophysiology. SARAH Network of Rehabilitation Hospitals, Brasília, DF, Brazil.<br /><searchLink fieldCode="AU" term="%22Ventura+FD%22">Ventura FD</searchLink>; Department of Clinical Neurophysiology. SARAH Network of Rehabilitation Hospitals, Brasília, DF, Brazil.<br /><searchLink fieldCode="AU" term="%22Dominici+M%22">Dominici M</searchLink>; Department of Clinical Neurophysiology. SARAH Network of Rehabilitation Hospitals, Brasília, DF, Brazil.<br /><searchLink fieldCode="AU" term="%22Pinheiro+DS%22">Pinheiro DS</searchLink>; Department of Clinical Neurophysiology. Federal University of São Paulo, São Paulo, SP, Brazil.<br /><searchLink fieldCode="AU" term="%22Simon+MV%22">Simon MV</searchLink>; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
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  Data: <searchLink fieldCode="JN" term="%22100883319%22">Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology</searchLink> [Clin Neurophysiol] 2026 Sep; Vol. 189, pp. 2111888. <i>Date of Electronic Publication: </i>2026 Apr 07.
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  Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22Elsevier%22">Elsevier </searchLink><i>Country of Publication: </i>Netherlands <i>NLM ID: </i>100883319 <i>Publication Model: </i>Print-Electronic <i>Cited Medium: </i>Internet <i>ISSN: </i>1872-8952 (Electronic) <i>Linking ISSN: </i><searchLink fieldCode="IS" term="%2213882457%22">13882457 </searchLink><i>NLM ISO Abbreviation: </i>Clin Neurophysiol <i>Subsets: </i>MEDLINE
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  Data: <searchLink fieldCode="MM" term="%22Reflex%22">Reflex*</searchLink>/<searchLink fieldCode="MM" term="%22Reflex+physiology%22">physiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Spinal+Cord%22">Spinal Cord*</searchLink>/<searchLink fieldCode="MM" term="%22Spinal+Cord+physiology%22">physiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Intraoperative+Neurophysiological+Monitoring%22">Intraoperative Neurophysiological Monitoring*</searchLink>/<searchLink fieldCode="MM" term="%22Intraoperative+Neurophysiological+Monitoring+methods%22">methods</searchLink> <br /><searchLink fieldCode="MM" term="%22Efferent+Pathways%22">Efferent Pathways*</searchLink>/<searchLink fieldCode="MM" term="%22Efferent+Pathways+physiology%22">physiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Afferent+Pathways%22">Afferent Pathways*</searchLink>/<searchLink fieldCode="MM" term="%22Afferent+Pathways+physiology%22">physiology</searchLink><br /><searchLink fieldCode="MH" term="%22Electric+Stimulation%22">Electric Stimulation</searchLink>/<searchLink fieldCode="MH" term="%22Electric+Stimulation+methods%22">methods</searchLink> ; <searchLink fieldCode="MH" term="%22Muscle%2C+Skeletal%22">Muscle, Skeletal</searchLink>/<searchLink fieldCode="MH" term="%22Muscle%2C+Skeletal+physiology%22">physiology</searchLink> ; <searchLink fieldCode="MH" term="%22Muscle%2C+Skeletal%22">Muscle, Skeletal</searchLink>/<searchLink fieldCode="MH" term="%22Muscle%2C+Skeletal+innervation%22">innervation</searchLink> ; <searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Female%22">Female</searchLink> ; <searchLink fieldCode="MH" term="%22Male%22">Male</searchLink> ; <searchLink fieldCode="MH" term="%22Adult%22">Adult</searchLink> ; <searchLink fieldCode="MH" term="%22Middle+Aged%22">Middle Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Aged%22">Aged</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: To describe spinal reflex responses mediated by the upper lumbar spinal cord in humans and observed intraoperatively under general anesthesia.<br />Methods: Thirty-one participants undergoing spinal surgery were enrolled. Reflex responses were recorded from the iliopsoas, adductor magnus, and rectus femoris muscles following electrical stimulation of the cutaneous territory innervated by the genitofemoral and ilioinguinal nerves using a multipulse train paradigm.<br />Results: Reflex responses were obtained in the iliopsoas, adductor magnus, and rectus femoris muscles, with distinct recordability rates and neurophysiological characteristics. The most robust and consistently reproducible responses were recorded in the iliopsoas muscle; this response pattern was termed the Genitoinguinal Reflex (GNIR).<br />Conclusions: GNIR components can be reliably elicited in humans under general anesthesia. Stimulation frequently produced proximal thigh movement, which may interfere with surgery and therefore necessitates intermittent application when safe.<br />Significance: The identification of these reflex responses expands current knowledge of human spinal cord circuitry. Moreover, GNIR recording may represent a useful intraoperative neurophysiological technique for monitoring the integrity of the upper lumbar spinal cord, L1-L2 nerve roots, and the genitofemoral, ilioinguinal, and femoral nerves.<br /> (Copyright © 2026 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)
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  Data: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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  Data: <i>Keywords: </i>Femoral nerve; Genitofemoral nerve; Genitoinguinal reflex; Ilioinguinal nerve; Intraoperative neurophysiological monitoring; Spinal cord reflexes
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