Tined Lead Placement - Axonics 1201 Mode D'emploi

4. Using the CP (outside the sterile field), gradually increase the stimulation amplitude to obtain appropriate S3
motor and/or sensory response (Table 2).
Motor response
Nerve Pelvic Floor
S2
Potential clamp response
(anterior-posterior contraction
of the perineal structures; a
clamp-like contraction of the
anal sphincter, and in males, a
retraction of the penis base)
S3
Bellows (flattening and
deepening of the buttock
groove due to the lifting and
dropping of the pelvic floor)
S4 Bellows
5. Observe the patient's motor responses to stimulation.
6. If not using EMG, Look for the desired gross motor responses in the buttocks/perineum and leg/foot.
-OR-
If using EMG, look for appropriate EMG signals from the big toe and perineal muscles.
7. If the patient is awake, ask the patient to describe the sensation of the stimulation including the location
(pelvic floor, vagina, testes, rectum/anus, bladder, scrotum, etc.) and quality (pulling, tapping, etc.) of the
sensation.
8. Use the CP to reduce the stimulation amplitude to zero once appropriate responses are noted.
9. If the desired responses are not seen, reposition the needle higher and more medially in the foramen and/
or change the angle of the needle as deemed appropriate. If the response is still not as desired, test at one
foramen level above or below. Testing the contralateral side should also be considered as this may also
improve the response.
Note: Due to anatomical variations in nerve location, the appropriate nerve responses may be seen at different
foramen levels.
10. When testing is complete, decrease the stimulation amplitude to zero and disconnect the needle test
stimulation cable from the needle.

Tined lead placement

1. Make a small incision on the lateral side of the foramen needle (in the direction where the tunneling will occur
towards the Neurostimulator pocket).
2. Remove the stylet from the foramen needle (Figure 9).
Table 2. Motor and sensory responses to sacral nerve stimulation
Leg/Foot
Rotation of the leg/hip rotation,
rotation of the heel, calf
contraction
Flexing great toe, occasionally
flexing of other toes
None
PROPOSED AXONICS FIGURE
Figure 9. Remove the stylet from the foramen needle.
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Sensory response
Generally none or may have a
sensation in the buttocks
Pulling in rectum, extending
forward to scrotum or labia
Pulling in rectum