title: Sacral nerve stimulation lead implantation using the O-arm.
abstract: BACKGROUND
  Sacral neuromodulation operations have usually been performed based on 2D fluoro images. However, sacral nerve stimulation lead implantation may be challenging when the normal anatomy is confused by obesity or congenital anomalies. Thus the surgical navigation and intraoperative imaging methods could be helpful as those same methods have proven to be feasible methods for guiding other surgical operations. Our recent knowledge about the O-arm in trauma pelvic operations encouraged us to evaluate the usefulness of O-arm guided navigation in sacral neuromodulation. Similar navigation would be useful for complex sacral nerve stimulation lead implantations.
  
  
  METHODS
  In this preliminary article we report our experience of utilizing the orthopedically optimized O-arm to implant the S3 stimulation electrode in a patient. The 3D O-arm imaging was performed intraoperatively under surgical navigation control. General anesthesia was used. The obtained 3D image dataset was registered automatically into the patient's anatomy. The stimulation needle was guided and the tined lead electrode was implanted using navigation.
  
  
  RESULTS
  The bony sacral structures were clearly visualized. Due to automatic registration, the navigation was practicable instantly after the O-arm scanning and operation could be performed successfully under navigation control.
  
  
  CONCLUSIONS
  To our knowledge, this is the first published tined lead implantation which was guided based on the surgical navigation and intraoperative O-arm images. In this case, the applied method was useful and helped the surgeon to demarcate the region of surgical interest. The method is slightly more invasive than the formal technique but could be an option in anatomically challenging cases and reoperations. However, further evaluation with larger patient series is required before definitive recommendations can be made.
authors.forename: Pekka A
authors.initials: PA
authors.lastname: Hellström
authors.forename: Jani
authors.initials: J
authors.lastname: Katisko
authors.forename: Pertti
authors.initials: P
authors.lastname: Finnilä
authors.affiliation: Division of Operative Care and Medical Research Center, Oulu University Hospital, P,O, Box 20, Oulu, FIN 90029 OYS, Finland. markku.vaarala@oulu.fi.
authors.forename: Markku H
authors.initials: MH
authors.lastname: Vaarala
mesh_terms: D004567:Electrodes, Implanted; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D010865:Pilot Projects; D019919:Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D015641:Radiography, Interventional / Q000295:instrumentation; D012447:Sacrum / Q000601:surgery; D062187:Spinal Cord Stimulation / Q000295:instrumentation* / Q000379:methods*; D013127:Spinal Nerves / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000517:prevention & control*