SpringerLink
Log in

Surface anatomical landmarks for the location of posterior sacral foramina in sacral nerve stimulation

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

Sacral nerve stimulation is a common treatment for various pelvic floor disorders. It consists of the percutaneous introduction of electrodes through the posterior sacral foramina for therapeutic stimulation of the target sacral spinal nerve. The aim of our study was to determine the surface anatomical landmarks of the sacrum to facilitate identification of the posterior sacral foramina.

Methods

This study was conducted on 20 human cadavers. The cadavers were placed in a prone position, and all the soft tissues of the sacral region were removed to allow exposure of the osseous structures. Different measurements were taken in relation to the posterior sacral foramina, the posterior superior iliac spine (PSIS) and the median sacral crest (MSC). A median coefficient of variation (CV) was determined.

Results

The diameter of the second sacral foramen showed the greatest variability. The distances between each individual foramen and the MSC had an acceptable variability (CV < 20%). In contrast, the distance between foramina had a high variability. The distance between PSIS and the second posterior sacral foramen was also found to have an acceptable variability (CV < 20%). However, the angle formed by an horizontal line between PSIS and a line between PSIS and S2 foramina had high variability.

Conclusions

We found that the distance between sacral foramina and MSC is relatively constant while the distance between foramina and the relations between foramina and PSIS is highly variable. Detailed knowledge of the anatomy may facilitate electrode placement and is complementary to the regular use of fluoroscopy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Matzel KE (2007) Sacral Nerve Stimulation. In: Ratto C, Doglietto GB (eds) Fecal Incontinence: diagnosis and treatment. Springer, Italy, pp 211–217

    Chapter  Google Scholar 

  2. Wexner SD, Coller JA, Devroede G et al (2012) Sacral nerve stimulation for fecal incontinence—results of a 120-patient prospective multicenter study. Ann Surg 251:441–449

    Article  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  4. Matzel KE, Kamm MA, Stösser M et al (2004) Sacral spinal nerve stimulation for faecal incontinence: multicentre study. Lancet 363:1270–1276

    Article  PubMed  Google Scholar 

  5. Madoff RD, Laurberg S, Lehur P et al (2013) Surgery for faecal incontinence. In: Cardozo L, Khoury S, Wein A (eds) Incontinence, 5th edn. Abrams, ICUD-EAU

  6. Hasan TS, Shanahan DA, Pridie AK, Neal DE (1996) Surface localization of sacral foramina for neuromodulation of bladder function- an anatomical study. Eur Urol 29:90–98

    CAS  PubMed  Google Scholar 

  7. Prapasrivorakul S, Gorissen KJ, Gosselink MP et al (2014) Temporary sacral neuromodulation under local anasesthesia using new anatomical reference points. Tech Coloproctol 18:1093–1097

    Article  CAS  PubMed  Google Scholar 

  8. Standring S (2008) Gray’s anatomy: the anatomical basis of clinical practice, 40th edn. Churchill Livinstone

  9. Deveneau NE, Greenstein M, Mahalingashetty A et al (2015) Surface and boney landmarks for sacral neuromodulation: a cadaveric study. Int Urogynecol J 26:263–268

    Article  PubMed  Google Scholar 

  10. McGrath MC, Stringer MD (2011) Bony landmarks in the sacral region: the posterior superior iliac spine and the second dorsal sacral foramina: a potential guide for sonography. Surg Radiol Anat 33:279–286

    Article  PubMed  Google Scholar 

  11. Asher MA, Strippgen WE (1986) Anthropometric studies of the human sacrum relating to dorsal trans-sacral implant designs. Clin Orthop Relat Res 203:58–62

    Google Scholar 

  12. Buchs NC, Dembe JC, Robert-Yap J, Roche B, Fasel J (2008) Optimizing electrode implantation in sacral nerve stimulation- an anatomical cadaver study controlled by a laparoscopic camera. Int J Colorectal Dis 23:85–91

    Article  CAS  PubMed  Google Scholar 

  13. Liguoro D, Viejo-Fuertes D, Midy D, Guerin J (1999) The posterior sacral foramina: an anatomical study. J Anat 195:301–304

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anatomy, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal

    A. Povo, M. Arantes & M. A. Ferreira

  2. Department of Surgery, University of Erlangen, Erlangen, Germany

    K. E. Matzel

  3. Centre for Medical Education, Faculty of Medicine of the University of Porto, Porto, Portugal

    J. Barbosa & M. A. Ferreira

  4. Department of Anatomy, NOVA Medical School, Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal

    D. Pais

  5. Department of Anatomy, Faculty of Medicine, Autonomous University of Barcelona, Barcelona, Spain

    A. Rodríguez-Baeza

Authors
  1. A. Povo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Arantes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. E. Matzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Barbosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. A. Ferreira
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. Pais
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Rodríguez-Baeza
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Povo.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was conducted on human cadavers donated to the Department of Anatomy Nova Medical School, NOVA University of Lisbon and to the Department of Anatomy, Faculty of Medicine, Autonomous University of Barcelona. This study was approved by the ethics committee of each institution.

Informed cosent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Povo, A., Arantes, M., Matzel, K.E. et al. Surface anatomical landmarks for the location of posterior sacral foramina in sacral nerve stimulation. Tech Coloproctol 20, 859–864 (2016). https://doi.org/10.1007/s10151-016-1543-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-016-1543-2

Keywords

Search

Navigation