Korean J Pain.  2016 Jan;29(1):23-28. 10.3344/kjp.2016.29.1.23.

Caudal Neuromodulation with the Transforaminal Sacral Electrode (InterStim(R)): Experience in a Pain Center Regarding 12 Implants

• Alonso Guardo L
• Cano Gala
• Sanchez Poveda D
• Rueda Juan P
• Sanchez Montero FJ
• Garzon Sanchez JC
• Santos Lamas JI
• Sanchez Hernandez MV

• KMID: 2151656
• DOI: http://doi.org/10.3344/kjp.2016.29.1.23

Abstract

BACKGROUND
Sacral nerve stimulation is a therapeutic option with demonstrated efficacy for conditions presenting with perineal pain caused by different etiologies. We aimed to assess whether a sacral electrode (InterStim(R), Medtronic, Minneapolis, MN, USA) inserted through the caudal pathway is able to offer an acceptable level of sacral stimulation and rate of catheter migration.
METHODS
We present 12 patients with pelvic pain who received sacral neuromodulation via the sacral hiatus with the InterStim electrode. We evaluated patient satisfaction as well as migration and removal of the electrode, if necessary.
RESULTS
Our experience included 12 patients, 10 women and two men, with a mean age of 60 years. In eight of the 12 patients, the initial therapy was effective, and the final system implantation was performed. During subsequent follow-up, patient satisfaction was good. To date, there have been no cases of electrode displacement or migration.
CONCLUSIONS
The caudal insertion of the InterStim electrode, with its own fixation system, and initially designed for transsacral insertion, appears in our experience to be a satisfactory option which can minimize electrode displacements, achieving similar results in therapeutic efficacy and causing no difficulties in removal.

Keyword

Implantable neurostimulator; Outcome assessment; Pain; Perineum; Sacrococcygeal region; Sacrum; Spinal cord stimulation

MeSH Terms

Catheters
Electrodes*
Female
Follow-Up Studies
Humans
Implantable Neurostimulators
Male
Pain Clinics*
Patient Satisfaction
Pelvic Pain
Perineum
Sacrococcygeal Region
Sacrum
Spinal Cord Stimulation

Figure

• 

  Fig. 1 Radioscope image showing the electrode inserted through the caudal pathway. AP.

• 

  Fig. 2 Radioscope image showing the electrode inserted through the caudal pathway. Lateral.

• 

  Fig. 3 Radioscope image showing the electrode, the extension line, and the pulse generator.

Reference

1. Aló KM, McKay E. Selective Nerve Root Stimulation (SNRS) for the treatment of intractable pelvic pain and motor dysfunction: a case report. Neuromodulation. 2001; 4:19–23. PMID: 22151567.

2. Alo KM, Yland MJ, Redko V, Feler C, Naumann C. Lumbar and sacral nerve root stimulation (NRS) in the treatment of chronic pain: a novel anatomic approach and neuro stimulation technique. Neuromodulation. 1999; 2:23–31. PMID: 22151059.

3. Feler CA, Whitworth LA, Fernandez J. Sacral neuromodulation for chronic pain conditions. Anesthesiol Clin North America. 2003; 21:785–795. PMID: 14719719.

4. Kohli N, Rosenblatt PL. Neuromodulation techniques for the treatment of the overactive bladder. Clin Obstet Gynecol. 2002; 45:218–232. PMID: 11862074.

5. Chodez M, Trilling B, Thuillier C, Boillot B, Barbois S, Faucheron JL. Results of sacral nerve neuromodulation for double incontinence in adults. Tech Coloproctol. 2014; 18:1147–1151. PMID: 25380739.

6. Steinberg AC, Oyama IA, Whitmore KE. Bilateral S3 stimulator in patients with interstitial cystitis. Urology. 2007; 69:441–443. PMID: 17382139.

7. El-Gazzaz G, Zutshi M, Salcedo L, Hammel J, Rackley R, Hull T. Sacral neuromodulation for the treatment of fecal incontinence and urinary incontinence in female patients: long-term follow-up. Int J Colorectal Dis. 2009; 24:1377–1381. PMID: 19488765.

8. Buffenoir K, Rioult B, Hamel O, Labat JJ, Riant T, Robert R. Spinal cord stimulation of the conus medullaris for refractory pudendal neuralgia: a prospective study of 27 consecutive cases. Neurourol Urodyn. 2015; 34:177–182. PMID: 24249588.

9. Hunter C, Davé N, Diwan S, Deer T. Neuromodulation of pelvic visceral pain: review of the literature and case series of potential novel targets for treatment. Pain Pract. 2013; 13:3–17. PMID: 22521096.

10. Kim JH, Hong JC, Kim MS, Kim SH. Sacral nerve stimulation for treatment of intractable pain associated with cauda equina syndrome. J Korean Neurosurg Soc. 2010; 47:473–476. PMID: 20617098.

11. Fariello JY, Whitmore K. Sacral neuromodulation stimulation for IC/PBS, chronic pelvic pain, and sexual dysfunction. Int Urogynecol J. 2010; 21:1553–1558. PMID: 20972541.

12. Mayer RD, Howard FM. Sacral nerve stimulation: neuromodulation for voiding dysfunction and pain. Neurotherapeutics. 2008; 5:107–113. PMID: 18164489.

13. Feler CA, Whitworth LA, Brookoff D, Powell R. Recent advances: sacral nerve root stimulation using a retrograde method of lead insertion for the treatment of pelvic pain due to interstitial cystitis. Neuromodulation. 1999; 2:211–216. PMID: 22151210.

14. Aló KM, Zidan AM. Selective nerve root stimulation (SNRS) in the treatment of end-stage, diabetic, peripheral neuropathy: a case report. Neuromodulation. 2000; 3:201–208. PMID: 22151525.

15. Aló KM, Gohel R, Corey CL. Sacral nerve root stimulation for the treatment of urge incontinence and detrusor dysfunction utilizing a cephalocaudal intraspinal method of lead insertion: a case report. Neuromodulation. 2001; 4:53–58. PMID: 22151611.

16. Richter EO, Abramova MV, Aló KM. Percutaneous cephalocaudal implantation of epidural stimulation electrodes over sacral nerve roots--a technical note on the importance of the lateral approach. Neuromodulation. 2011; 14:62–67. PMID: 21992164.

17. Thon WF, Baskin LS, Jonas U, Tanagho EA, Schmidt RA. Surgical principles of sacral foramen electrode implantation. World J Urol. 1991; 9:133–137.

18. Siegel SW, Catanzaro F, Dijkema HE, Elhilali MM, Fowler CJ, Gajewski JB, et al. Long-term results of a multicenter study on sacral nerve stimulation for treatment of urinary urge incontinence, urgency-frequency, and retention. Urology. 2000; 56(Suppl 1):87–91. PMID: 11114569.

19. Brazzelli M, Murray A, Fraser C. Efficacy and safety of sacral nerve stimulation for urinary urge incontinence: a systematic review. J Urol. 2006; 175:835–841. PMID: 16469561.

20. van Kerrebroeck PE, van Voskuilen AC, Heesakkers JP, Lycklama á, Siegel S, Jonas U, et al. Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study. J Urol. 2007; 178:2029–2034. PMID: 17869298.

21. Park CH, Kim BI. Sacral nerve stimulation through the sacral hiatus. Korean J Pain. 2012; 25:195–197. PMID: 22787552.