A Povo1,2,3, M Arantes4,5, K E Matzel6, J Barbosa7, M A Ferreira4. 1. Department of Anatomy, Faculty of Medicine, University of Porto, Porto, Portugal. anapovo@sapo.pt. 2. Centro Integrado de Cirurgia Ambulatório Centro Hospitalar do Porto, Porto, Portugal. anapovo@sapo.pt. 3. Department of Anatomy (Faculdade de Medicina Universidade do Porto), Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal. anapovo@sapo.pt. 4. Department of Anatomy, Faculty of Medicine, University of Porto, Porto, Portugal. 5. Instituto Português de Oncologia, Porto, Portugal. 6. Department of Surgery, University of Erlangen, Erlangen, Germany. 7. Center for Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal.
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.
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.
Authors: Steven D Wexner; John A Coller; Ghislain Devroede; Tracy Hull; Richard McCallum; Miranda Chan; Jennifer M Ayscue; Abbas S Shobeiri; David Margolin; Michael England; Howard Kaufman; William J Snape; Ece Mutlu; Heidi Chua; Paul Pettit; Deborah Nagle; Robert D Madoff; Darin R Lerew; Anders Mellgren Journal: Ann Surg Date: 2010-03 Impact factor: 12.969