Selective Nerve Root Stimulation (SNRS) for the Treatment of Intractable Pelvic Pain and Motor Dysfunction: A Case Report

Selective Nerve Root Stimulation (SNRS) in the Treatment of End-Stage, Diabetic, Peripheral Neuropathy: A Case Report

“…This report has provided further information on the feasibility and clinical effects of SNRS using a percutaneous caudad approach ( 4,37,39,49‐53). Future study is indicated in measuring, mapping and applying SNRS.…”

“…As a result of a general inability of early implanters to achieve consistent stimulation paresthesia into many of the T12‐S5 dermatomes from epidural electrodes placed over the spinal cord (C2‐T12), the general indications for stimulation in this region have only recently evolved. Many potential sensory, motor, and mixed conditions of the lumbosacral neuraxis including: genitofemoral neuralgia, ilioinguinal neuralgia, lumbar plexalgia, neural root or plexus injury, obturator neuropathy, sacral neuralgia/neuritis, pudendal neuralgia, interstitial cystitis, vulvodynia, coccygodynia, prostadynia, pelvic floor dysfunction, spinal cord injury, sexual dysfunction, detrusor dysynergia, and urge incontinence may ultimately be evaluated ( 37,39,49‐53). Also, early results are encouraging in lumbosacral radicular/radiculopathic pain, failed back surgical syndrome (FBSS), and CRPS poorly optimized with dual programmable SCS strategies ( 37).…”

Sacral Nerve Root Stimulation for the Treatment of Urge Incontinence and Detrusor Dysfunction Utilizing a Cephalocaudal Intraspinal Method of Lead Insertion: A Case Report

“…To date, the cephalocaudal “retrograde” approach has been applied successfully in long‐term follow‐up for the combined sensorimotor dysfunction of interstitial cystitis(7–10,12,13,21,22). As a result, we and other authors have identified the following potential clinical advantages for cephalocaudal vs. transsacral nerve/root applications: the ability to physiologically map the cauda equina from T12 through S5 in the awake patient; the ability to anatomically “stabilize” the electrode within the epidural space and/or sacral root sleeve; the ability to maintain “parallel” electrode symmetry and contact with the respective sacral roots; the ability to minimize the morbidity of open posterior sacral root dissections; the ability to use current “off the shelf” technology without the need for new, specialized hardware; the ability to apply electrodes more readily over multiple neural segments; the ability to work within an interdisciplinary team (urologist/anesthesiologist/neurosurgeon) in optimally evaluating, implanting, and managing the patient and system perioperatively; and the ability to more readily expand this effective application to more patients through appropriate training and education of the primary implanting pain practitioner group(21,22).…”

“…(Fig. 1) After nine months of unsuccessful medication adjustments, a “retrograde” epidural selective nerve root stimulation (SNRS) trial to the S2/3 level was recommended given past experience and success with this technique(7–13).…”

Percutaneous Cephalocaudal Implantation of Epidural Stimulation Electrodes Over Sacral Nerve Roots—A Technical Note on the Importance of the Lateral Approach

“…Sacral nerve root stimulation is an effective treatment for multiple chronic pelvic pain conditions (1,2). In 1997, a specific sacral nerve stimulation device (Interstim, Medtronic, Inc., Minneapolis, MN, USA) received FDA approval for the treatment of urge incontinence and then, in 1999, FDA granted approval for its use in patients with frequency‐urgency syndrome and non‐obstructive urinary retention (3).…”