Standardized fluoroscopy-guided implantation technique enables optimal electrode placement in sacral neuromodulation: a
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ORIGINAL ARTICLE
Standardized fluoroscopy‑guided implantation technique enables optimal electrode placement in sacral neuromodulation: a cadaver study C. Müller1 · L. F. Reissig2 · S. Argeny1 · W. J. Weninger2 · S. Riss1 Received: 28 June 2020 / Accepted: 22 October 2020 © The Author(s) 2020
Abstract 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. Keywords Sacral neuromodulation · Faecal incontinence · Electrode localization · Lead placement · Anatomical landmarks · Treatment success
Introduction Sacral neuromodulation (SNM) is an established treatment option for various pelvic disorders such as urinary incontinence, hyperactive bladder or faecal incontinence. A tined quadripolar electrode is implanted to stimulate the root of a sacral nerve preferentially of S3. Different approaches to localize the correct sacral foramen and to ideally place the electrode have been reported in the literature. * S. Riss [email protected] 1
Division of General Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18‑20, 1090 Vienna, Austria
Division of Anatomy, MIC Medical University of Vienna, Vienna, Austria
2
Accordingly, a consensus statement in 2015 showed that expert opinions vary regarding the optimal surgical technique [1]. The overall success of SNM depends on various factors. Notably, localization of the electrode and its proximity to the nerve are considered to be essential to achieve an optim
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