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Sacral malformations: use of imaging to optimise sacral nerve stimulation

International Journal of Colorectal Disease volume 31, pages 351–357 (2016)Cite this article

Abstract

Introduction

The success of sacral nerve stimulation, a common treatment for pelvic floor disorders, depends on correct placement of the electrodes through the sacral foramina. When the bony anatomy and topography of the sacrum and sacral spinal nerves are intact, this is easily achieved; where sacral anomalies exist, it can be challenging. A better understanding of common sacral malformations can improve the success of sacral nerve stimulation (SNS) electrode placement.

Material and methods

We reviewed 998 consecutive MRI scans performed to investigate low back pain in patients who had undergone CT and/or X-ray.

Results

Congenital sacral malformations were found in 24.1 %, the most common being sacral meningeal cysts (16 %) and spina bifida occulta (9.9 %). Others were lumbosacral transitional vertebrae (2.5 %), anterior occult meningocele (0.5 %), partial sacral agenesis (0.2 %) and vertebral dysplasia of S1 (0.2 %).

Conclusion

This radiologic review uncovered a high incidence of sacral malformations, and most were asymptomatic. All surgeons who perform SNS should have a basic understanding of sacral malformations, their incidence and effect on foraminal anatomy. Imaging will aid procedural planning.

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Acknowledgments

The authors offer their many thanks to Dr. Rocha e Melo, Lead Clinician of the Neuroradiology Unit at Hospital Pedro Hispano, and to Dr. Jorge Machado, Director of the Radiology Unit at the Hospital Pedro Hispano, for the opportunity to perform this work in their unit.

Author information

Affiliations

  1. Department of Anatomy, Faculty of Medicine, University of Porto, Porto, Portugal

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

  2. Centro Integrado de Cirurgia Ambulatório Centro Hospitalar do Porto, Porto, Portugal

    A. Povo

  3. Department of Anatomy (Faculdade de Medicina Universidade do Porto), Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal

    A. Povo

  4. Instituto Português de Oncologia, Porto, Portugal

    M. Arantes

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

    K. E. Matzel

  6. Center for Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal

    J. Barbosa

Authors
  1. A. Povo
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  2. M. Arantes
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  3. K. E. Matzel
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  4. J. Barbosa
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  5. M. A. Ferreira
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Corresponding author

Correspondence to A. Povo.

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Conflict of interest

Ana Povo, Mavilde Arantes, Joselina Barbosa and Maria Amélia Ferreira declare no conflicts of interest. Prof. Klaus Matzel is a Medical Advisor to Medtronic®. There has been no significant financial support for this work that could have influenced its outcome.

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Povo, A., Arantes, M., Matzel, K.E. et al. Sacral malformations: use of imaging to optimise sacral nerve stimulation. Int J Colorectal Dis 31, 351–357 (2016). https://doi.org/10.1007/s00384-015-2417-1

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  • DOI: https://doi.org/10.1007/s00384-015-2417-1

Keywords

  • Sacral malformations
  • Sacral nerve stimulation
  • Sacrum
  • Sacral plexus
  • Imaging anatomy