Surface anatomical landmarks for the location of posterior sacral foramina in sacral nerve stimulation

Povo, Ana; Arantes, Mavilde; Matzel, Klaus E.; Barbosa, Joselina; Ferreira, Maria Amélia; Pais, Diogo; Rodríguez‐Baeza, Alfonso

doi:10.1007/s10151-016-1543-2

Cited by 13 publications

(10 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although these bony landmarks can usually be identified easily, the operator's experience is essential for correct positioning, as the orientation of the sacral bone and the amount of subcutaneous fatty tissue varies among individuals. Indeed, cadaver studies have shown large variability in size and distance of bony sacral landmarks: e.g., the distance from the upper part of the S3 foramen to the tip of the coccyx has a mean of 9.26 cm, but in only 18 cadavers the range was 3.4 cm . If one relies on bony landmarks alone, lead placement could easily be at S2 or S4 in some of these patients.…”

Section: Resultsmentioning

confidence: 99%

Sacral Neuromodulation: Standardized Electrode Placement Technique

Matzel

Chartier‐Kastler

Knowles

et al. 2017

Neuromodulation: Technology at the Neural Interface

144

126

View full text Add to dashboard Cite

show abstract

Section: Resultsmentioning

confidence: 99%

Sacral Neuromodulation: Standardized Electrode Placement Technique

Matzel

Chartier‐Kastler

Knowles

et al. 2017

Neuromodulation: Technology at the Neural Interface

144

126

View full text Add to dashboard Cite

show abstract

“…Thus, one may speculate that this anatomical alteration may not be clinically relevant. In a study by Povo et al,20 human cadavers were dissected to define landmarks for optimal SNM lead placement, and no exostosis was described [13]. The age of the cadavers was not mentioned in their study.…”

Section: Discussionmentioning

confidence: 99%

Standardized fluoroscopy-guided implantation technique enables optimal electrode placement in sacral neuromodulation: a cadaver study

et al. 2020

View full text Add to dashboard Cite

Background Sacral neuromodulation (SNM) is an established treatment option for patients with faecal incontinence. The location of the stimulating electrode is considered to be essential for treatment success. The purpose of this study was to evaluate the position of SNM electrodes after using a standardized fluoroscopy-guided implantation technique. Methods For this cadaver study, SNM electrodes were implanted bilaterally in 5 lower body specimens. The lower edge of the sacroiliac joint and the medial edge of the sacral foramina were marked using fluoroscopy to draw an ‘H’ with the crossing points identifying S3. After electrode placement the pelvis was dissected to describe the exact position of the SNM electrodes. Results The electrodes were inserted at an angle with a median degree measure of 60° (range 50–65°) to the skin, with a median distance of 9 mm (range 0–13 mm) from the S3 marking. All electrodes entered the third sacral foramen. The median distance of the electrodes to the sacral nerve was 0 mm (range 0–3 mm) for the most proximal, 0.5 mm (range 0–5 mm) for the second, 2.25 mm (range 0–11 mm) for the third and 1.75 mm (range 0–16 mm) for the most distant electrode. There was neither a significant difference in the proximity of the electrodes to the nerve between the right and left side (proximal to distal electrode: p = 0.18, p = 0.16, p = 0.07, p = 0.07) nor between male and female cadavers (p = 0.25, p = 0.21, p = 0.66, p = 0.66). Conclusions A standardized fluoroscopy-guided implantation technique enables a close contact between electrode and nerve. This can potentially result in an improved clinical outcome.

show abstract

“…Harman demonstrated in 1899, in a series of six fetal cadavers, the intra‐ and inter‐individual variety of the origin of sacral nerves, pelvic plexus and pelvic splanchnic nerves . Povo and colleagues noted high variability in the distance between S3 and S4 on both sides and in the distance between S2 and S3 in adults . Although this was demonstrated in human cadavers, one could assume similarities to pigs.…”

Section: Discussionmentioning

confidence: 99%