Radiologically anatomic measurement analysis for the third sacral foramen and an efficient implantation protocol for sacral neuromodulation

Aims To define radiologically anatomic measurements for the S3 foramen and develop an efficient and straightforward implantation protocol for sacral neuromodulation (SNM) in a southern Chinese population. Methods We retrospectively reviewed 793 adults without sacrococcygeal abnormalities or bony injury. We generated CT-derived three-dimensional volumetric models and collected radiologically anatomic measurements of S3 foramen. A multiple generalized linear regression model was applied to evaluate implantation protocol for SNM. Results Height, weight, and sacral height were significantly different between enrolled patients based on sex (p < 0.001 for all), while age and sacral width were similar. The measurements L1, L2, A1, and A2 on both sides were similar, while based on sex, those of L1, A1, A2 showed significant differences [7.02 +/- 0.90 (M) vs. 6.10 +/- 0.99 cm (F) (p < 0.001); 83.05 +/- 6.23 (M) vs. 82.08 +/- 7.53 degrees (F) (p = 0.005); and 13.31 +/- 5.69 (M) vs. 11.97 +/- 4.91 degrees (F) (p < 0.001), respectively]. The multiple generalized linear regression model demonstrated that sex was a common independent factor for estimating L1, L2, A1, A2, while the consistency rate between the estimated model and actual measurements was poor. The measurements L1, L2, A1, and A2 were approximately 7.0 cm (M) versus 6.1 cm (F), 1.8 cm (M) versus 1.8 cm (F), 83 degrees (M) versus 82 degrees (F), and 13 degrees (M) versus 12 degrees (F), respectively. Conclusions This retrospective study indicates that the radiologically anatomic measurements for the S3 foramen have unique characteristics. Our study provides an efficient and straightforward implantation protocol for SNM, improving its use in China.