LSU Health Sciences Center, New Orleans, LA, USA.
Neuromodulation. 2011 Jan;14(1):62-7; discussion 67. doi: 10.1111/j.1525-1403.2010.00293.x. Epub 2010 Oct 7.
Idiopathic overactive bladder, urgency-frequency syndromes, interstitial cystitis, pudendal neuralgia, vulvodynia, prostadynia, and coccygodynia have been effectively treated with sacral nerve root modulation. This is most commonly performed with placement of electrodes via a transforaminal approach, predominately to the S3 foramen. This approach is limited by a high lead migration rate and the limitations of stimulating a single nerve root. Beginning in the 1990s, some centers began pursuing retrograde percutaneous placement from the lumbar spine, but adoption of this technique was limited by the technical difficulty of the approach.
We developed a lateral approach to the epidural space for these procedures, which has improved the learning curve and facilitated the application of the retrograde technique. In this technical note, we describe the "laterograde" approach.
A focused description of the technique is presented in this technical report. The epidural space is accessed from lateral to medial with the bevel facing up to keep the approach to the "shingled" lumbar laminae shallow.
The "laterograde" modification of cephalocaudal approach appears to be technically less difficult method for accomplishing sacral nerve root stimulator electrode placement over multiple roots.
特发性膀胱过度活动症、尿急-频综合征、间质性膀胱炎、阴部神经痛、外阴痛、前列腺痛和尾骨痛均可通过骶神经根调节得到有效治疗。这通常通过经椎间孔途径将电极放置来完成，主要是到 S3 孔。这种方法受到高导线迁移率和刺激单一神经根的局限性的限制。从 20 世纪 90 年代开始，一些中心开始从腰椎进行逆行经皮放置，但由于该技术的难度，这种技术的应用受到限制。
我们为这些手术开发了一种硬膜外腔的外侧入路，这改善了学习曲线，并促进了逆行技术的应用。在本技术说明中，我们描述了“顺行”方法。
本技术报告对该技术进行了重点描述。从外侧到内侧进入硬膜外腔，斜面朝上，以保持“层叠”腰椎板的进入路径较浅。
对于完成多个神经根的骶神经根刺激器电极放置，“顺行”改良的头侧尾侧入路似乎是一种技术上较不困难的方法。
