Patterns of tined lead migration in sacral nerve modulation

Ezra, E.; Siilin, A M Helene; Gulobovic, Milan; Graf, Juergen

doi:10.1007/s00384-020-03530-0

Cited by 3 publications

(2 citation statements)

References 12 publications

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“…For the diagnosis of migration posterior-anterior and lateral radiographs at baseline and after the loss of efficacy are fundamental. Small changes in the lead position are very common, Ezra E et al, reported some degree of lead migration in 100% of their patients, 35% migrated backward and 74% of the patients had a forward migration [8]. A forward migration was observed in 50% of the patients who suffered loss of efficacy.…”

Section: Discussionmentioning

confidence: 99%

Sacral Nerve Stimulation Lead Migration through the Sciatic Foramen, Successfully Repositioned

Elorza-Echaniz¹,

Borda-Arrizabalaga²,

Aguirre–Allende³

et al. 2021

SCR

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Introduction: SNS (Sacral Nerve Stimulation) has become an established minimally invasive procedure for urinary and faecal incontinence. Minor complications related to the procedure are common; include pain, infection or migration. We present a case of a tined lead migration through the sciatic foramen. Case Report: A 72-year-old woman with faecal incontinence, who did not respond to dietary of medical treatment, underwent a sacral nerve stimulation test. Under fluoroscopic vision a tined lead was placed in S3 foramen, with an adequate motor and sensory response. In the 7th postoperative day, she reported no improvement and she referred sensory response in the thigh and leg. Radiography showed migration of the electrode through the sciatic foramen. The repositioning of the same electrode was possible with a gentle traction of the lead. Correct placement of the lead was confirmed radiologically, and the patient showed motor and sensory response in the anal area. The patient improved Wexner score from 18/20 to 4/20. Conclusion: Migration of the tined lead should be considered if loss of response in found. Repositioning of the same lead is possible in selected patients, without the need of removal of the device.

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Section: Discussionmentioning

confidence: 99%

Sacral Nerve Stimulation Lead Migration through the Sciatic Foramen, Successfully Repositioned

Elorza-Echaniz¹,

Borda-Arrizabalaga²,

Aguirre–Allende³

et al. 2021

SCR

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show abstract

“…A recent study comparing SNM trial success in patients with overactive bladder, urinary retention and FI found no continuous association between the motor thresholds and trial success ( Adelstein et al, 2019 ). Further, lead migration post-implantation is a common occurrence which requires reprogramming and can lead to loss of efficacy ( Ezra et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Electrophysiological Responses in the Human S3 Nerve During Sacral Neuromodulation for Fecal Incontinence

et al. 2021

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Intra-operative electrode placement for sacral neuromodulation (SNM) relies on visual observation of motor contractions alone, lacking complete information on neural activation from stimulation. This study aimed to determine whether electrophysiological responses can be recorded directly from the S3 sacral nerve during therapeutic SNM in patients with fecal incontinence, and to characterize such responses in order to better understand the mechanism of action (MOA) and whether stimulation is subject to changes in posture. Eleven patients undergoing SNM were prospectively recruited. A bespoke stimulating and recording system was connected (both intraoperatively and postoperatively) to externalized SNM leads, and electrophysiological responses to monopolar current sweeps on each electrode were recorded and analyzed. The nature and thresholds of muscle contractions (intraoperatively) and patient-reported stimulation perception were recorded. We identified both neural responses (evoked compound action potentials) as well as myoelectric responses (far-field potentials from muscle activation). We identified large myelinated fibers (conduction velocity: 36–60 m/s) in 5/11 patients, correlating with patient-reported stimulation perception, and smaller myelinated fibers (conduction velocity <15 m/s) in 4/11 patients (not associated with any sensation). Myoelectric responses (observed in 7/11 patients) were attributed to pelvic floor and/or anal sphincter contraction. Responses varied with changes in posture. We present the first direct electrophysiological responses recorded from the S3 nerve during ongoing SNM in humans, showing both neural and myoelectric responses. These recordings highlight heterogeneity of neural and myoelectric responses (relevant to understanding MOA of SNM) and confirm that electrode lead position can change with posture.

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Functional mapping of the lower urinary tract by epidural electrical stimulation of the spinal cord in decerebrated cat model

Sysoev,

Bazhenova,

Shkorbatova

et al. 2024

Sci Rep

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Several neurologic diseases including spinal cord injury, Parkinson’s disease or multiple sclerosis are accompanied by disturbances of the lower urinary tract functions. Clinical data indicates that chronic spinal cord stimulation can improve not only motor function but also ability to store urine and control micturition. Decoding the spinal mechanisms that regulate the functioning of detrusor (Detr) and external urethral sphincter (EUS) muscles is essential for effective neuromodulation therapy in patients with disturbances of micturition. In the present work we performed a mapping of Detr and EUS activity by applying epidural electrical stimulation (EES) at different levels of the spinal cord in decerebrated cat model. The study was performed in 5 adult male cats, evoked potentials were generated by EES aiming to recruit various spinal pathways responsible for LUT and hindlimbs control. Recruitment of Detr occurred mainly with stimulation of the lower thoracic and upper lumbar spinal cord (T13-L1 spinal segments). Responses in the EUS, in general, occurred with stimulation of all the studied sites of the spinal cord, however, a pronounced specificity was noted for the lower lumbar/upper sacral sections (L7-S1 spinal segments). These features were confirmed by comparing the normalized values of the slope angles used to approximate the recruitment curve data by the linear regression method. Thus, these findings are in accordance with our previous data obtained in rats and could be used for development of novel site-specific neuromodulation therapeutic approaches.

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Patterns of tined lead migration in sacral nerve modulation

Cited by 3 publications

References 12 publications

Sacral Nerve Stimulation Lead Migration through the Sciatic Foramen, Successfully Repositioned

Sacral Nerve Stimulation Lead Migration through the Sciatic Foramen, Successfully Repositioned

Electrophysiological Responses in the Human S3 Nerve During Sacral Neuromodulation for Fecal Incontinence

Functional mapping of the lower urinary tract by epidural electrical stimulation of the spinal cord in decerebrated cat model

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