ABSTRACT
This case series describes the use of ultrasound (US)-guided dorsal sacral foraminal block (DSFB) for providing postoperative analgesia in six patients who underwent foot and ankle surgeries under spinal anesthesia. Postoperatively, all of them received a US-guided DSFB at the level of the brim of the second sacral foramina (SF2). Needle placements were confirmed with fluoroscopic (FL) images and injected radiocontrast defined the diffusion with a postoperative CT scan. The images obtained depicted ipsilateral spread in the sacral epidural space, sacral nerve roots, and plexus. The US-guided DSFB could be effectively used as an alternative method for postoperative pain relief after foot and ankle surgery.
ABSTRACT
Sacral nerve stimulation (SNS) is an established treatment for faecal incontinence involving the implantation of a quadripolar electrode into a sacral foramen, through which an electrical stimulus is applied. Little is known about the induced spread of electric current around the SNS electrode and its effect on adjacent tissues, which limits optimisation of this treatment. The authors constructed a 3-dimensional imaging based finite element model in order to calculate and visualise the stimulation induced current and coupled this to biophysical models of nerve fibres. They investigated the impact of tissue inhomogeneity, electrode model choice and contact configuration and found a number of effects. (i) The presence of anatomical detail changes the estimate of stimulation effects in size and shape. (ii) The difference between the two models of electrodes is minimal for electrode contacts of the same length. (iii) Surprisingly, in this arrangement of electrode and neural fibre, monopolar and bipolar stimulation induce a similar effect. (iv) Interestingly when the active contact is larger, the volume of tissue activated reduces. This work establishes a protocol to better understand both therapeutic and adverse stimulation effects and in the future will enable patient-specific adjustments of stimulation parameters.
ABSTRACT
Objective: To explore the application and efficacy of 3D printing technology of computed tomography 3D reconstruction and computer-assisted design in sacral neuromodulation. Methods: This is a randomized, controlled, prospective study. From March 2017 to March 2018, 15 candidates for sacral neuromodulation were randomized into traditional puncture group (n=10) and 3D printing group (n = 5). X-ray guided electrode placement was used in the traditional puncture group, and 3D printing navigation template puncture was applied in the 3D printing group. The clinical efficacy of the two groups was evaluated. Puncture time, needle insertion times, intraoperative adjustment and testing time, and postoperative complications (such as wound bleeding, wound infection, wound dehiscence, electrode breakage, displacement or prolapse) were assessed. Results: There were no significant differences in gender, age, sacral neural foramen size, sacrococcygeal deformity, or disease type between the two groups (all P>0.05). Compared with those in the traditional puncture group, the puncture time, needle insertion times, intraoperative adjustment and testing time were significantly decreased in the 3D printing group ([9.10 ± 2.73] min vs [26.20 ± 5.67] min, 3.20 ± 0.84 vs 5.30±1.30, [20.80 ± 3.27] min vs [27.60 ± 4.63] min; t=6.301, 3.255, 2.916; all P<0.05). Complications such as wound infection, wound bleeding, wound dehiscence, electrode breakage, displacement or prolapse, or pain of stimulator, were not found after operation. Conclusion: Compared with traditional method, computer-assisted 3D printing technology is safe in sacral neuromodulation. It can reduce the needle insertion times, shorten the puncture time, and improve the efficiency of intraoperative adjustment and testing.
ABSTRACT
A sacrum with five pairs of foramina is an anatomical variant resulting from sacralisation of lumbar vertebra at cranial end or sacralisation of coccyx vertebra at caudal end. An unusual gross variation nurtures interest of anatomists and causes concern for clinicians when it mimics pathology. A sacrum with fifth anomalous pair of sacral foramina has been observed which prompted the author to examine the available sacra in the osteology lab of Department of Anatomy KG Medical University Lucknow, UP, India. Of the total sixty six observed sacra, those with five pairs of sacral foramina due to sacralisation of lumbar vertebra were found in eleven cases (16.6%) while those due to sacralisation of coccygeal vertebra were observed in nine cases (13.6%). These sacralisations were classified in five categories to systematise the anatomical study, causes and clinical complications. Sacralisation of lumbar vertebra may compress the fifth sacral nerve causing sciatica and back pain. It may also cause herniation of disc above sacralisation. Sacralisation of coccygeal vertebra may influence the caudal block anaesthesia in surgical procedures and also results in prolonged second stage of labor and perineal tears.
Un sacro con cinco pares de forámenes es una variante anatómica que resulta de la sacralización de la vértebra lumbar al extremo craneal o sacralización de la vértebra coxis al extremo caudal. Esta variación inusual es de interés para los anatomistas como también motivo de preocupación para los médicos al asemejar una patología. Un sacro con un quinto par anómalo de forámenes fue observado, por lo que se examinaron otros sacros del laboratorio de osteología del Departamento de Anatomía Médica de la Universidad de Lucknow, India. De un total de 66 sacros estudiados, en 11 casos (16,6%) se observaron cinco pares de forámenes sacros, debido a la sacralización de la vértebra lumbar; mientras que en 9 casos (13,6%), se observó la sacralización de la vértebra caudal. Estos fueron clasificados en cinco categorías para sistematizar el estudio anatómico, sus causas y complicaciones clínicas. La sacralización de la vértebra lumbar puede comprimir el quinto nervio, causando ciática sacra y dolor de espalda. También puede causar una hernia discal superior a la sacralización. La sacralización de la vértebra caudal, puede influir en la anestesia de bloqueo caudal en procedimientos quirúrgicos y también dar lugar a una prolongada etapa del trabajo de parto y desgarros perineales.
