Current Position of Sacral Neuromodulation in Treatment of Fecal Incontinence

AbstractFecal incontinence (FI) is defined as uncontrolled passage of feces or gas for at least 1-month duration in an individual who previously had control. FI is a common and debilitating condition affecting many individuals. Continence depends on complex relationships between anal sphincters, rectal curvatures, rectoanal sensation, rectal compliance, stool consistency, and neurologic function. Factors, such as pregnancy, chronic diarrhea, diabetes mellitus, previous anorectal surgery, urinary incontinence, smoking, obesity, limited physical activity, white race, and neurologic disease, are known to be the risk factors for FI. Conservative/medical management including biofeedback are recognized as the first-line treatment of the FI. Those who are suitable for surgical intervention and who have failed conservative management, sacral nerve stimulation (SNS) has emerged as the treatment of choice in many patients. The surgical technique involves placement of a tined lead with four electrodes through the S3 sacral foramen. The lead is attached to a battery, which acts as a pulse generator, and is placed under the patient's skin in the lower lumbar region. The use of SNS in the treatment of FI has increased over the years and the beneficial effects of this treatment have been substantiated by multiple studies. This review describes SNS as a modality of treatment for FI and its position in the current medical diaspora in patients with FI.

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Removal of sacral neuromodulation quadripolar tined-lead using a straight stylet: description of a surgical technique

Techniques in Coloproctology ◽

10.1007/s10151-020-02403-6 ◽

2021 ◽

Author(s):

M. Agnello ◽

M. Vottero ◽

P. Bertapelle

Keyword(s):

Adverse Effects ◽

Sacral Neuromodulation ◽

Pulse Generator ◽

Lead Removal ◽

Open Technique ◽

Implantable Pulse Generator ◽

Beneficial Effects ◽

Tined Lead ◽

Removal Technique ◽

Sacral Bone

Abstract Background Up to 7.5% of tined-lead removals in patients having sacral neuromodulation (SNM) therapy are associated with a lead breakage. It is still unclear what adverse effects can be caused by unretrieved fragments. The aim of our study was to describe the lead removal technique we have been using for the last 2 years in our centre. Methods We retrospectively enrolled patients who had lead removal between January 2018 and January 2020 using our standardized technique. The novelty of the technique is in the use of the straight stylet, which is available in the quadripolar tined-lead kit. The stylet gives the electrode greater stiffness, reducing interactions with surrounding tissues and probability of damage or breakage during removal. Results In 59 patients (42 women, mean age 57.2 years [range 40–79 years]) the lead was removed using our standardized technique. In 44 of 59 patients, the tined-lead was removed within 2 months from the SNM-test, due to lack of beneficial effects. In 15 patients the electrode was removed because of failure of definitive implantation. Meantime from definitive implantable pulse generator (IPG) implantation to lead removal was 67.9 months. We recorded only 1 case of lead-breakage during removal: a female patient with a non-tined lead fixed on sacral bone, placed 18 years previously using an open technique. Conclusions Lead breakage during removal is not uncommon and adverse effects of retained fragments may occur. Our technique has been safely used for the last 2 years in our centre, with no episodes of lead breakage or retained fragments, except for one non-tined electrode.

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Sensitivity of Intersegmental Angles of the Spinal Column to Errors Due to Marker Misplacement

Journal of Biomechanical Engineering ◽

10.1115/1.4030406 ◽

2015 ◽

Vol 137 (7) ◽

Cited By ~ 2

Author(s):

Hossein Rouhani ◽

Sara Mahallati ◽

Richard Preuss ◽

Kei Masani ◽

Milos R. Popovic

Keyword(s):

Relative Error ◽

Sagittal Plane ◽

Gaussian Function ◽

Spinal Column ◽

Transverse Plane ◽

Lumbar Region ◽

Experimental Errors ◽

Rms Error ◽

Lower Lumbar ◽

Anterior Direction

The ranges of angular motion measured using multisegmented spinal column models are typically small, meaning that minor experimental errors can potentially affect the reliability of these measures. This study aimed to investigate the sensitivity of the 3D intersegmental angles, measured using a multisegmented spinal column model, to errors due to marker misplacement. Eleven healthy subjects performed trunk bending in five directions. Six cameras recorded the trajectory of 22 markers, representing seven spinal column segments. Misplacement error for each marker was modeled as a Gaussian function with a standard deviation of 6 mm, and constrained to a maximum value of 12 mm in each coordinate across the skin. The sensitivity of 3D intersegmental angles to these marker misplacement errors, added to the measured data, was evaluated. The errors in sagittal plane motions resulting from marker misplacement were small (RMS error less than 3.2 deg and relative error in the angular range less than 15%) during the five trunk bending direction. The errors in the frontal and transverse plane motions, induced by marker misplacement, however, were large (RMS error up to 10.2 deg and relative error in the range up to 58%), especially during trunk bending in anterior, anterior-left, and anterior-right directions, and were often comparable in size to the intersubject variability for those motions. The induced errors in the frontal and transverse plane motions tended to be the greatest at the intersegmental levels in the lower lumbar region. These observations questioned reliability of angle measures in the frontal and transverse planes particularly in the lower lumbar region during trunk bending in anterior direction, and thus did not recommend interpreting these measures for clinical evaluation and decision-making.

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The volume of true heterotopies of the spinal cord

Kazan medical journal ◽

10.17816/kazmj48290 ◽

1902 ◽

Vol 2 (11-12) ◽

pp. 612-630

Author(s):

V. Methodiev

Keyword(s):

Spinal Cord ◽

Lumbar Region ◽

Normal Spine ◽

Lower Lumbar

Here it is necessary to disassemble separately the doubling of the spinal cord in the normal spine and the doubling that sometimes accompanies the so-called. spinam bifidam (mainly in the lower lumbar region).

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Extradural Myxopapillary Ependymoma arising in the lower lumbar region

Nigerian Journal of Orthopaedics and Trauma ◽

10.4314/njotra.v9i1.54742 ◽

2010 ◽

Vol 9 (1) ◽

Author(s):

A Agrawal ◽

A Kakani ◽

A Bhake ◽

A Agrawa ◽

N Meshram ◽

...

Keyword(s):

Myxopapillary Ependymoma ◽

Lumbar Region ◽

Lower Lumbar

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Measurement of the nerve root of the lower lumbar region using digital images

Medicine ◽

10.1097/md.0000000000009848 ◽

2018 ◽

Vol 97 (8) ◽

pp. e9848 ◽

Cited By ~ 1

Author(s):

Xin Zhao ◽

Jie Zhao ◽

Jie Guan ◽

Junkai Zeng ◽

Chen Han ◽

...

Keyword(s):

Nerve Root ◽

Digital Images ◽

Lumbar Region ◽

Lower Lumbar

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Design and Development of a Modular Medical Simulation Prototype for Pediatric Spinal Detethering Surgeries

Journal of Medical Devices ◽

10.1115/1.4024304 ◽

2013 ◽

Vol 7 (2) ◽

Author(s):

Joshua Bailey ◽

Kalyani Nair ◽

Alyssa Macuk ◽

Christopher Frank ◽

Ankit Patel ◽

...

Keyword(s):

Spinal Cord ◽

Medical Students ◽

Surgical Procedure ◽

Pressure Sensors ◽

Pressure Profile ◽

Medical Simulation ◽

Lumbar Region ◽

Noise Elimination ◽

Simulation Tools ◽

Lower Lumbar

Medical simulation is a developing field used in the education of medical students, doctors, residents, and many other medical professionals. Despite emerging simulation tools, little has been done to address surgeries in congenital patients, specifically with regards to the spinal cord. The objective of this project was to design, fabricate, and functionally evaluate a medical simulator to address the challenge of teaching the spinal detethering surgical procedure to neurosurgery residents. This simulator was designed to mimic anatomical and physiological characteristics of the lower lumbar region. Pressure sensors were used to quantify the forces that were applied to the spinal cord during the surgical procedure and a LabVIEW program was developed to monitor the pressure profile. The simulator was functionally evaluated by six residents, one fellow, one doctor, and two medical students. A conclusive, quantitative method for scoring these surgeries has not yet been developed, however, the residents and medical students were able to compare their procedures with those of more experienced doctors and fellows via qualitative methods. Future developments will include incorporating quantitative scoring methods as well as noise elimination hardware into the design.

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Clearance of Unusual Muscular Uptake of F-18 FDG in the Lower Lumbar Region on a Repeat FDG-PET Scan After Oral Chlorzoxazone Intervention

Clinical Nuclear Medicine ◽

10.1097/01.rlu.0000223213.64074.2a ◽

2006 ◽

Vol 31 (7) ◽

pp. 412-413

Author(s):

Gaurav Malhotra ◽

N Nair ◽

N S. Baghel ◽

S H. Moghe

Keyword(s):

Fdg Pet ◽

Pet Scan ◽

Lumbar Region ◽

Fdg Pet Scan ◽

Lower Lumbar

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Demonstration of the Feasibility of Implantation of a Skeletal Muscle Pulse Generator for Fecal Incontinence in a Patient with an Implanted Unipolar DDD Pacemaker

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.1992.tb06848.x ◽

1992 ◽

Vol 15 (5) ◽

pp. 825-830 ◽

Cited By ~ 5

Author(s):

JOOP KONSTEN ◽

COR G.M.I. BAETEN ◽

KAREL DEN DULK ◽

FRANK SPAANS

Keyword(s):

Skeletal Muscle ◽

Fecal Incontinence ◽

Pulse Generator

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Morphological Analysis of the Human Lumbar Spine Using Sagittal Magnetic Resonance Imaging

Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care ◽

10.1177/2327857921101026 ◽

2021 ◽

Vol 10 (1) ◽

pp. 59-62

Author(s):

Ge Wu ◽

Yu Liu ◽

Wen Wen ◽

Yang Zhang ◽

Ruoliang Tang ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Vertebral Body ◽

Body Height ◽

Lumbar Region ◽

Low Back ◽

Monthly Basis ◽

Work Related ◽

Two Samples ◽

Lower Lumbar

Sagittal morphological dimensions of the human lower lumbar structures are critical inputs for the comprehensive biomechanical modeling of spinal motions and the risk assessment of work-related low back pain. In this new quantitative exploration of sagittal morphology across the lower lumbar region (i.e., from L3/L4 to L5/S1), intervertebral disc (IVD) height, vertebral body (VB) height, endplate concavity was measured from two samples of subjects, including 1) archived medical records (AMR) collected from 57 patients and 2) 43 asymptomatic subjects with no history of low back pain (ASYM), independently by four individuals on a monthly basis. First, the current study achieved good inter- and intra-rater reliabilities. In addition, the current results also revealed that AMR sample had greater anterior-to-posterior vertebral body height ratio in vertebra L3 and L5. On the other hand, ASYM sample had significantly greater endplate concavity.

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