Korean J Pain.  2012 Jul;25(3):195-197. 10.3344/kjp.2012.25.3.195.

Sacral Nerve Stimulation Through the Sacral Hiatus

• Park CH
• Kim BI

• KMID: 2278156
• DOI: http://doi.org/10.3344/kjp.2012.25.3.195

Abstract

Sacral nerve stimulation through the retrograde approach has been used for peroneal or irritable bowel syndrome through the retrograde approach. However, several reasons, lead could not be advanced down ward. In this case, anterograde sacral nerve stimulation through the sacral hiatus could be used. The aim of this report is to present of technique of sacral nerve root stimulation through the sacral hiatus approach.

Keyword

anterograde; sacral nerve stimulation; spinal cord stimulation

MeSH Terms

Irritable Bowel Syndrome
Spinal Cord Stimulation

Figure

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  Fig. 1 A 15-gauge Tuohy needle was advanced under fluoroscopic guidance through the sacral hiatus (A) and right and left octapolar lead was passed through the needle until cephalad electrode was at the S3 level (B).

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  Fig. 2 A 5 cm incision was made at the Tuohy needle insertion site.

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  Fig. 3 A second incision was made between the lead insertion site and the implantable pulse generator pocket site and the lead was passed through the tunnel into second subcutaneous pocket.

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  Fig. 4 The leads were tunneled to the pocket and connected to the generator.

Reference

1. 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.

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

3. Dudding TC, Hollingshead JR, Nicholls RJ, Vaizey CJ. Sacral nerve stimulation for faecal incontinence: patient selection, service provision and operative technique. Colorectal Dis. 2011; 13:e187–e195. PMID: 21689330.

4. Yang KS, Kim YH, Park HJ, Lee MH, Kim DH, Moon DE. Sacral nerve stimulation for treatment of chronic intractable anorectal pain -a case report-. Korean J Pain. 2010; 23:60–64. PMID: 20552076.

5. Tanagho EA, Schmidt RA. Electrical stimulation in the clinical management of the neurogenic bladder. J Urol. 1988; 140:1331–1339. PMID: 3057221.

6. 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.

7. 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.

8. Aló KM, Holsheimer J. New trends in neuromodulation for the management of neuropathic pain. Neurosurgery. 2002; 50:690–703. PMID: 11904018.

9. Falco FJ, Rubbani M, Heinbaugh J. Anterograde sacral nerve root stimulation (ASNRS) via the sacral hiatus: benefits, limitations, and percutaneous implantation technique. Neuromodulation. 2003; 6:219–214.