DOI QR코드

DOI QR Code

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

  • Guardo, Laura Alonso (Pain Management Department, Anesthesiology and Perioperative Medicine Department, Health Center Complex of Salamanca) ;
  • Gala, Carlos Cano (Trauma and Orthopaedic Surgery Department, Health Center Complex of Salamanca) ;
  • Poveda, David Sanchez (Pain Management Department, Anesthesiology and Perioperative Medicine Department, Health Center Complex of Salamanca) ;
  • Juan, Pablo Rueda (Bioingeneer Medtronic Latinoamerica) ;
  • Sanchez Montero, Francisco Jose (Pain Management Department, Anesthesiology and Perioperative Medicine Department, Health Center Complex of Salamanca) ;
  • Garzon Sanchez, Jose Carlos (Pain Management Department, Anesthesiology and Perioperative Medicine Department, Health Center Complex of Salamanca) ;
  • Lamas, Juan Ignacio Santos (Pain Management Department, Anesthesiology and Perioperative Medicine Department, Health Center Complex of Salamanca) ;
  • Sanchez Hernandez, Miguel Vicente (Pain Management Department, Anesthesiology and Perioperative Medicine Department, Health Center Complex of Salamanca)
  • Received : 2015.05.06
  • Accepted : 2015.12.08
  • Published : 2016.01.01

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.

Keywords

References

  1. Alo 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. https://doi.org/10.1046/j.1525-1403.2001.00019.x
  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. https://doi.org/10.1046/j.1525-1403.1999.00023.x
  3. Feler CA, Whitworth LA, Fernandez J. Sacral neuromodulation for chronic pain conditions. Anesthesiol Clin North America 2003; 21: 785-95. https://doi.org/10.1016/S0889-8537(03)00085-3
  4. Kohli N, Rosenblatt PL. Neuromodulation techniques for the treatment of the overactive bladder. Clin Obstet Gynecol 2002; 45: 218-32. https://doi.org/10.1097/00003081-200203000-00023
  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: 1147-51. https://doi.org/10.1007/s10151-014-1231-z
  6. Steinberg AC, Oyama IA, Whitmore KE. Bilateral S3 stimulator in patients with interstitial cystitis. Urology 2007; 69: 441-3. https://doi.org/10.1016/j.urology.2006.10.032
  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: 1377-81. https://doi.org/10.1007/s00384-009-0745-8
  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: 177-82. https://doi.org/10.1002/nau.22525
  9. Hunter C, Dave 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. https://doi.org/10.1111/j.1533-2500.2012.00558.x
  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: 473-6. https://doi.org/10.3340/jkns.2010.47.6.473
  11. Fariello JY, Whitmore K. Sacral neuromodulation stimulation for IC/PBS, chronic pelvic pain, and sexual dysfunction. Int Urogynecol J 2010; 21: 1553-8. https://doi.org/10.1007/s00192-010-1281-3
  12. Mayer RD, Howard FM. Sacral nerve stimulation: neuromodulation for voiding dysfunction and pain. Neurotherapeutics 2008; 5: 107-13. https://doi.org/10.1016/j.nurt.2007.10.063
  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: 211-6. https://doi.org/10.1046/j.1525-1403.1999.00211.x
  14. Alo KM, Zidan AM. Selective nerve root stimulation (SNRS) in the treatment of end-stage, diabetic, peripheral neuropathy: a case report. Neuromodulation 2000; 3: 201-8. https://doi.org/10.1046/j.1525-1403.2000.00201.x
  15. Alo 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: 53-8. https://doi.org/10.1046/j.1525-1403.2001.00053.x
  16. Richter EO, Abramova MV, Alo 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: 62-7. https://doi.org/10.1111/j.1525-1403.2010.00293.x
  17. Thon WF, Baskin LS, Jonas U, Tanagho EA, Schmidt RA. Surgical principles of sacral foramen electrode implantation. World J Urol 1991; 9: 133-7.
  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.
  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: 835-41. https://doi.org/10.1016/S0022-5347(05)00326-5
  20. van Kerrebroeck PE, van Voskuilen AC, Heesakkers JP, Lycklama a Nijholt AA, 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: 2029-34. https://doi.org/10.1016/j.juro.2007.07.032
  21. Park CH, Kim BI. Sacral nerve stimulation through the sacral hiatus. Korean J Pain 2012; 25: 195-7. https://doi.org/10.3344/kjp.2012.25.3.195

Cited by

  1. Sacral neuromodulation for pelvic pain and pelvic organ dysfunction: A case series vol.58, pp.1, 2018, https://doi.org/10.1111/ajo.12752
  2. Sacral Burst Neuromodulation via Caudal Approach as a Treatment for Chronic Coccydynia pp.10947159, 2018, https://doi.org/10.1111/ner.12808
  3. Neuromodulation for Chronic Pelvic Pain vol.19, pp.5, 2018, https://doi.org/10.1007/s11934-018-0783-2
  4. Effect of transforaminal epidural polydeoxyribonucleotide injections on lumbosacral radiculopathy : A case report vol.96, pp.25, 2016, https://doi.org/10.1097/md.0000000000007174
  5. Sacral neuromodulation treating chronic pelvic pain: a meta-analysis and systematic review of the literature vol.30, pp.7, 2016, https://doi.org/10.1007/s00192-019-03898-w