Needle Placement and Position of Electrical Stimulation Inside Sacral Foramen Determines Pelvic Floor Electromyographic Response—Implications for Sacral Neuromodulation

Pelvic Floor Muscle Electromyography as a Guiding Tool During Lead Placement and (Re)Programming in Sacral Neuromodulation Patients: Validity, Reliability, and Feasibility of the Technique

“…The use of EMG as a tool to provide better lead placement (3,16) and guide troubleshooting (4,5,7) for patients with SNM has been advocated. However, its use is not yet universally spread and different methods have been described.…”

“…Comparison of PFM contractions between patients is also possible, but it is important to keep in mind not all PFM are able to elicit the same force during contraction, hence one than should correct for this maximal PFM contraction potential. Using this EMG technique, a difference was identified in the ability to elicit PFM contractions upon stimulation depending on the position of the lead electrodes within the sacral foramen (16). Moreover, using this technique, assessment of changes in PFM activity, lead displacement, and the difference in PFM activation upon stimulation of different lead electrode configurations during SNM treatment is possible.…”

Pelvic floor activation upon stimulation of the sacral spinal nerves in sacral neuromodulation patients

“…This activation pattern is the most prominent upon stimulating electrodes which are located nearest to the sacral foramen (electrode #3). Recently, it is shown that PFM EMG is a feasible tool to assist during lead electrode placement 12 as well as during (re)programming. 7 Research such as this, which attempts to "neuromap" the pelvic floor, has the potential to provide more guidance during lead electrode placement and (re)programming, ultimately resulting in improved clinical outcomes.…”

Needle Placement: A Guide to Predictable Sensory and Motor Responses Based on Variations in Needle Placement During Sacral Neuromodulation Procedures

“…By recognizing and correcting these common needle trajectory placements and subsequent lead placements intraoperatively, practitioners can more consistently achieve the desired motor and sensory responses with optimal placement. By changing needle trajectory intraoperatively to position the needle approximately 1 cm superiorly and parallel to the bone seam, the practitioner can achieve optimal placement as set forth by the already existing standardized criteria and as demonstrated by Vaganee et al [2] showing statistically significant higher mean electromyographic values for leads placed cranially and medially within the S3 foramen. Of note, this paper has attempted to define a way to predict motor and sensory responses from SNM therapy in the average patient population.…”