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Surface and boney landmarks for sacral neuromodulation: a cadaveric study.

Nicolette E Deveneau¹, Miriam Greenstein, Abhijit Mahalingashetty

¹Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology, and Women's Health, University of Louisville School of Medicine, Louisville, KY, USA.

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Summary

A 9 cm distance from the coccyx is a reasonable starting point for percutaneous nerve evaluation (PNE). However, anatomical variability necessitates caution and confirmation with sensory-motor response for accurate S3 sacral foramen placement.

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Area of Science:

Anatomy
Neurology
Medical Device Technology

Background:

Percutaneous nerve evaluation (PNE) often relies on external landmarks for needle placement.
The validity of standard landmarks, such as 9 cm from the coccyx for the S3 sacral foramen, requires empirical assessment.

Purpose of the Study:

To evaluate the accuracy of the 9 cm external landmark for identifying the S3 sacral foramen.
To determine if other bony landmarks improve needle positioning accuracy for in-office PNE.

Main Methods:

Cadaveric dissection of 22 embalmed specimens.
Measurement of distances between external bony landmarks and sacral foramina.
Placement of spinal needles at the standard 9 cm superior to coccyx and 2 cm lateral to midline.

Main Results:

The mean distance from the coccyx tip to the S3 sacral foramen was 9.26 cm.
Needle placement accuracy showed variability, with equal likelihood of being above or below the S3 foramen.
No significant correlations were found between external measurements and accurate S3 foramen localization.

Conclusions:

The 9 cm landmark from the coccyx is a practical starting point for blind in-office PNE.
Variability in coccyx length necessitates careful consideration and confirmation of needle placement.
Sensory-motor response is crucial for verifying correct S3 sacral foramen targeting during PNE.