Sacral Neuromodulation: Standardized Electrode Placement Technique

Klaus E. Matzel*, Emmanuel Chartier-Kastler, Charles H. Knowles, Paul A. Lehur, Arantxa Munoz-Duyos, Carlo Ratto, Mona B. Rydningen, Michael Sorensen, Philip van Kerrebroeck, Stefan de Wachter

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

80 Citations (Web of Science)

Abstract

IntroductionSacral 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((R))).

MethodAn 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.

ResultsKey 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.

ConclusionStandardization 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.

Original languageEnglish
Pages (from-to)816-824
Number of pages9
JournalNeuromodulation
Volume20
Issue number8
DOIs
Publication statusPublished - Dec 2017

Keywords

  • Fecal incontinence
  • pelvic organ dysfunction
  • sacral nerve stimulation
  • sacral neuromodulation
  • urinary incontinence
  • FECAL INCONTINENCE
  • NERVE-STIMULATION
  • LANDMARKS
  • SURFACE

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