Abstract
Introduction and hypothesis
Standard external landmarks have been suggested as a guide for in-office percutaneous nerve evaluation (PNE), but validity of these landmarks has not been assessed. Our objective was to determine whether the standard 9 cm from the tip of the coccyx indicates the position of the S3 sacral foramen and whether other boney landmarks and measurements improved positioning.
Methods
Measurements and distances between external boney landmarks were obtained in 22 embalmed cadavers. Spinal needles were placed 9 cm superior to the coccyx and 2 cm lateral to midline bilaterally. After dissection, internal measurements relating to sacral length, position of S3, and location of the needle in relation to S3 were recorded. Correlations among measured variables were assessed using descriptive statistics.
Results
Mean distance from the tip of coccyx to S3 was 9.26 cm (±0.84), from S3 to midline 2.30 cm (±0.2); from needle to S3 1.25 cm, and needle placement was as likely to be placed above or below S3; and S2-S3 and S3-S4 interforamenal distance 1.48 cm (±0.30) and 1.48 cm (±0.24), respectively. Mean distance from S3 to sacroiliac joint (SIJ) was shorter than S2 to SIJ. All associations between external measurements and length from tip of coccyx to S3 were not significant.
Conclusion
A distance 9 cm from the tip of the coccyx is a reasonable starting landmark for in-office blind PNE. However, given the variability in coccyx length, caution should be taken; also, sensory-motor response is necessary to confirm proper placement.
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Acknowledgements
The authors thank Ryan Newton, PhD, Jonathan Weeks, MD, and Adair Heyl, PhD for their contribution to the preparation of this manuscript. We also thank the individuals who donated their bodies and tissues for the advancement of education and research.
Conflicts of interest
Dr. Francis is a speaker for Astellas Pharma Inc. Dr. Ostergard has provided services in the form of medicolegal consultation and testimony and is a speaker for Astellas Pharma Inc. All other authors have no conflict of interest.
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Deveneau, N.E., Greenstein, M., Mahalingashetty, A. et al. Surface and boney landmarks for sacral neuromodulation: a cadaveric study. Int Urogynecol J 26, 263–268 (2015). https://doi.org/10.1007/s00192-014-2504-9
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DOI: https://doi.org/10.1007/s00192-014-2504-9