Background: Pudendal neuralgia is a debilitating
pain syndrome, and fi nding long-lasting treatment
modalities has been challenging in pain
management. Sacral nerve stimulation (SNS)
has emerged as a treatment option for pudendal
neuralgia but the correct placement of SNS
leads can be challenging. Previously described
techniques include placing the stimulator at the
conus, as well as retrograde and transforaminal
approaches.
Objective: We aim to describe the relevant
anatomy and technique for precise SNS lead
placement using a sacrococcygeal approach.
Study Design: A technical report.
Setting: An interventional pain management
practice.
Methods: Description with accompanying fl uoroscopic
and anatomical images; this technical
report describes the specifi c technique we employed
in 7 patients suffering from intractable
pelvic pain as a result of pudendal neuralgia.
Results: Successful placement of percutaneous
SNS leads using a sacrococcygeal approach in
all 7 patients suffering from pudendal neuralgia.
Six of the 7 patients experienced a decrease in
the visual analog scale (VAS) pain score (> 50%),
improvement in function during the trial period,
and proceeded with permanent neurosurgical
implantation. Four out of 6 patients that underwent
permanent implantation reported persistent pain
relief and improvement in the activities of daily living
at long-term follow-up (range: 12–33 months).
Limitations: The design of this study limits the
ability to determine the defi nitive risks, potential
complications, and long-term benefi ts. The precise
clinical value of this approach remains to be
determined in larger prospective studies.
Conclusions: Although infrequently performed,
the sacrococcygeal approach may represent a
more successful and safe alternative method for
the placement of SNS leads for a SNS trial.
Key words: Technical note, neuromodulation,
sacral nerve stimulation, pudendal neuralgia,
pelvic pain, SCS, SNS