Sacral nerve stimulation lead implantation in partial sacral agenesis using intra‐operative computerized tomography

Diego, Julio Castillo; Cristóbal, Lara; Alonso, J.; Martin, Ruth Elwood; Suárez, D; Martínez, Miguel S. Vallés; Cagigas, Carmen; Gómez-Ruiz, Marcos; Gómez-Fleitas, Manuel; Vázquez-Barquero, Alfonso

doi:10.1111/codi.13437

Cited by 11 publications

(6 citation statements)

References 6 publications

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“…Similar cases with lower limbs hypotonia have been described in the literature [16,18]. As neurologic manifestations, and anal sphincter atony has been found like in Castillo et al [19]; but it has been described many other neurologic consequences of the CRS like bowel dysfunction, neurogenic bladder [6,7,20].…”

Section: Discussionsupporting

confidence: 63%

Atypical caudal regression syndrome with lumbar agenesis, hypoplastic sacrum without sacro-iliac joints in the Eastern Democratic Republic of Congo: A case report

Safari¹,

Murhega²,

Nteranya³

2022

J Clin Images Med Case Rep

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Lumbosacral agenesis is a rare and complex malformation characterized by a total or partial absence of the lumbosacral vertebrae. It is often associated with other congenital malformations. Its etiology is poorly understood but factors such as gestational diabetes, genetic abnormalities and environmental factors are incriminated. We report the case of a female infant, 11 months old, who presented with lumbosacral agenesis. As our hospital was less equipped to deal with this complex malformation, we transferred the infant to another better equipped hospital.

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Section: Discussionsupporting

confidence: 63%

Atypical caudal regression syndrome with lumbar agenesis, hypoplastic sacrum without sacro-iliac joints in the Eastern Democratic Republic of Congo: A case report

Safari¹,

Murhega²,

Nteranya³

2022

J Clin Images Med Case Rep

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“…Some other innovative strategies have been developed in the field of sacral neuromodulation, always aiming to facilitate technical aspects of electrode insertion or optimize outcomes. Recently, as previously mentioned, neuronavigation and CT-guided procedures has been successful in aiding electrode insertion [3], even with the development of experimental animal models to try and optimize standard techniques [16]. However, possible limitations of this technique are the availability of a CT-scan suite for the intervention, the difficulty in strictly defining the insertion zone with a patient in prone position and awake, who can move and be uncomfortable if kept still for a prolonged period of time, and the high radiation of CT compared with simple X-ray.…”

Section: Discussionmentioning

confidence: 93%

“…Current solutions for the more complex or anomalous sacral anatomies rely on intra-operative CT combined with neuronavigation, a synergistic use of advanced technologies leading to quicker and 2 of 15 safer guidance [3]. Nevertheless, intra-operative CT navigation for spine surgery implies additional radiation exposure, both to patients-almost up to three times more-and to surgeons, who receive a not negligible dose even if the patients are exposed to almost nine times more radiation than the medical professionals [4].…”

Section: Introductionmentioning

confidence: 99%

Surgical Planning of Sacral Nerve Stimulation Procedure in Presence of Sacral Anomalies by Using Personalized Polymeric Prototypes Obtained with Additive Manufacturing Techniques

Rubio-Pérez

Lantada

2020

Polymers

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Sacral nerve stimulation or sacral neuromodulation involves the implantation of a stimulating electrode lead through the sacral foramina. In patients with anatomical sacral anomalies, it can constitute a challenging procedure due to a lack of common reference points present in the normal anatomy. In this study, we present an innovative application of additive manufacturing for the planning of sacral nerve stimulation techniques and related surgical procedures in complex cases, and we verify that the use of personalized patient models may help to manage the presence of sacral anomalies. The use of two alternative additive manufacturing technologies working with thermoplastic and thermoset polymers, including fused deposition modeling as low-cost alternative and laser stereolithography as industrial gold standard, is compared in terms of viability, precision and overall production costs. They pay special attention to fidelity in terms of the bone microstructure reconstruction, which is necessary for adequately planning electrode insertion. Advantages and limitations of the alternative approaches are discussed and ideas for future developments and for solving current challenges are presented.

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“…The customized 3D printed guiding device permitted precise entry of the test needle into the target foramen with a consistent angle of 60° in the sagittal plane, which is recommended following cadaveric studies . The technique is different from another three‐dimensional implant approach assisted by an intra‐operative O‐arm CT instrument . One of the great advantages of the current 3D printed guider is its ‘portable’ feature which opens the possibility of ‘remote application’ of SNS in the future.…”

Section: Discussionmentioning

confidence: 99%

A novel three‐dimensional printed guiding device for electrode implantation of sacral neuromodulation

Cui

Wang

et al. 2018

Colorectal Disease

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Aim The aim was to test the feasibility of a novel threedimensional (3D) printed guiding device for electrode implantation of sacral neuromodulation (SNM).Method A 3D printed guiding device for electrode implantation was customized to patients' anatomy of the sacral region. Liquid photopolymer was selected as the printing material. The details of the device designation and prototype building are described. The guiding device was used in two patients who underwent SNM for intractable constipation. Details of the procedure and the outcomes are given.Results With the help of the device, the test needle for stimulation was placed in the target sacral foramen successfully at the first attempt of puncture in both patients. The time to implant a tined SNM electrode was less than 20 min and no complications were observed. At the end of the screening phase, symptoms of constipation were relieved by more than 50% in both patients and permanent stimulation was established. ConclusionThe customized 3D printed guiding device for implantation of SNM is a promising instrument that facilitates a precise and quick implantation of the electrode into the target sacral foramen.

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Sacral nerve stimulation lead implantation in partial sacral agenesis using intra‐operative computerized tomography

Abstract: Our experience showed that O-arm guided navigation can be used to overcome the difficulty of SNS lead placement in patients with partial sacral agenesis who have faecal incontinence.

Cited by 11 publications

References 6 publications

Atypical caudal regression syndrome with lumbar agenesis, hypoplastic sacrum without sacro-iliac joints in the Eastern Democratic Republic of Congo: A case report

Atypical caudal regression syndrome with lumbar agenesis, hypoplastic sacrum without sacro-iliac joints in the Eastern Democratic Republic of Congo: A case report

Surgical Planning of Sacral Nerve Stimulation Procedure in Presence of Sacral Anomalies by Using Personalized Polymeric Prototypes Obtained with Additive Manufacturing Techniques

A novel three‐dimensional printed guiding device for electrode implantation of sacral neuromodulation

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