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Letters to the Editor  |   February 2017
Landmark Article Transforms Traditional View of the Autonomic Nervous System
Author Notes
  • New York Institute of Technology College of Osteopathic Medicine, Old Westbury 
Article Information
Gastroenterology / Neuromusculoskeletal Disorders / Obstetrics and Gynecology / Osteopathic Manipulative Treatment / Urological Disorders / OMT in the Laboratory
Letters to the Editor   |   February 2017
Landmark Article Transforms Traditional View of the Autonomic Nervous System
The Journal of the American Osteopathic Association, February 2017, Vol. 117, 72. doi:10.7556/jaoa.2017.016
The Journal of the American Osteopathic Association, February 2017, Vol. 117, 72. doi:10.7556/jaoa.2017.016
On November 18, 2016, Science published a landmark article titled “The Sacral Autonomic Outflow Is Sympathetic” by Espinosa-Medina et al.1 The authors used immunofluorescence and immunohistochemistry to define distinguishing genetic features between parasympathetic and sympathetic pre- and postganglionic neurons in mice. Fifteen morphologic and morphogenetic features that differentiate these segments of the autonomic nervous system were observed. For each feature identified, sacral outflow was identical to thoracolumbar outflow and distinct from cranial outflow. Furthermore, the authors demonstrated that (1) sacral preganglionic neurons mature as sympathetic neurons do, (2) all pelvic ganglionic cells express sympathetic transcription factors, and (3) the pelvic ganglion develops independently of the pelvic nerve as sympathetics do. Therefore, the authors concluded that the sacral autonomic nervous system is sympathetic in nature. These data demonstrate that the sympathetic nervous system derives input via spinal nerves from the thoracic to the sacral spine and that the parasympathetic nervous system derives input solely from the cranial nerves. Indeed, organs once thought to derive parasympathetic innervation from sacral autonomics (eg, left part of colon, lower ureter, bladder, uterus, prostate, genitals) instead derive sympathetic innervation from this system. 
These data transform our traditional view of the autonomic nervous system as well as the current osteopathic manipulative treatment modalities that address sacral autonomic nerves (eg, sacralinhibition). In fact, sacral techniques previously intended to target the parasympathetic nervous system may have been addressing the sympathetic nervous system. Such modalities should now be reconsidered in light of this scientific discovery. Moreover, these findings suggest a new potential of osteopathic manipulative treatment techniques, particularly those applied to the cranium, in influencing the parasympathetic nervous system in the human body. 
References
Espinosa-Medina I, Saha O, Boismoreau F, et al The sacral autonomic outflow is sympathetic. Science. 2016;354(6314):893-898. [CrossRef] [PubMed]