Sacral Neuromodulation: Standardized Electrode Placement Technique

Carlo Ratto, Klaus E. Matzel, Emmanuel Chartier-Kastler, Charles H. Knowles, Paul A. Lehur, Arantxa Muñoz-Duyos, Mona B. Rydningen, Michael Sørensen, Philip Van Kerrebroeck, Stefan De Wachter

Risultato della ricerca: Contributo in rivistaArticolo in rivista

64 Citazioni (Scopus)

Abstract

Introduction: Sacral neuromodulation (SNM) (sacral nerve stimulation SNS) has become an established therapy for functional disorders of the pelvic organs. Despite its overall success, the therapy fails in a proportion of patients. This may be partially due to inadequate electrode placement with suboptimal coupling of the electrode and nerve. Based on these assumptions the technique of sacral spinal neuromodulation has been redefined. All descriptions relate to the only currently available system licensed for all pelvic indications (Medtronic Interstim®). Method: An international multidisciplinary working party of ten individuals highly experienced in performing SNM convened two meetings (including live operating) to standardize the implant procedure. This report addresses the main steps to optimal electrode lead placement in temporal sequence. Results: Key elements of the electrode placement are radiological marking, the use of a curved stylet, the entry of the electrode into the sacral foramen and its progression through the foramen, its placement guided by a combination of a typical appearance in fluoroscopy and achieving specific motor/sensory responses with stimulation. The report describes quadripolar electrode placement and then either insertion of a connecting percutaneous extension lead or permanent implantation of the programmable device. Conclusion: Standardization of electrode placement may ensure close electrode proximity to the target nerve providing a higher likelihood for optimal effect with less energy consumption (better battery longevity), more programming options with more electrode contacts close to the nerve and reduced likelihood of side-effects. The potentially better clinical outcome needs to be demonstrated.
Lingua originaleEnglish
pagine (da-a)816-824
Numero di pagine9
RivistaNeuromodulation
Volume20
DOI
Stato di pubblicazionePubblicato - 2017

Keywords

  • Antibiotic Prophylaxis
  • Electric Stimulation Therapy
  • Electrodes, Implanted
  • Fecal Incontinence
  • Fecal incontinence
  • Humans
  • Interdisciplinary Research
  • Lumbosacral Plexus
  • Patient Care Team
  • Patient Positioning
  • Sacrum
  • pelvic organ dysfunction
  • sacral nerve stimulation
  • sacral neuromodulation
  • urinary incontinence

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