Logan Couture had a goal 15 seconds after Lidstrom’s second, Dan Boyle scored midway through the middle period to pull San Jose within 3-2, and Dany Heatley tied it early in the third.
Helm put Detroit back ahead for good, scoring from the left circle off a cross-ice pass from Patrick Eaves, who got the puck off a long rebound following Brian Rafalski’s shot.
Jimmy Howard made 25 saves for the win. San Jose’s Antti Niemi stopped 26 shots.
The second-round rematch has mirrored last year’s matchup between the teams. San Jose won the first three games by a goal each time, but couldn’t complete the sweep.
Todd Bertuzzi scored first this time 6:22 in, just as he did last year in Game 4, when he gave Detroit a 1-0 lead at 5:40.
The Red Wings went on to win that game 7-1 before getting eliminated in Game 5.
Detroit appeared to be on the way to another blowout win after Lidstrom scored twice in the first period to make it 3-0, but San Jose refused to get routed.
Couture quieted Joe Louis Arena at 18:16 of the first, and Boyle silenced the fired-up fans when he made it 2-1 at 13:44 of the second.
Detroit had chances to add to its lead in the second, but went 0 for 3 on the power play in the period.
San Jose didn’t have a power play in the first two periods.
The Sharks got their chance 4:12 into the third, shortly after tying the game, but they didn’t take advantage. San Jose had another power play with 8:25 left and failed to score.
Bertuzzi started the scoring with a spectacular play, making a 360-degree spin with the puck and beating Niemi with a backhander from the right circle.
From the other circle, Lidstrom’s slap shot off a long rebound made it 2-0 midway through the first period. Lidstrom got control of a pass with his left skate, whacked the puck out of the air, and bounced it past Niemi.
The cheers turned to groans seconds later when Helm had a giveaway, and Howard gave up what seemed like a soft goal to Couture.
Howard went low and Boyle shot high after a cross-ice pass caught back-checking forward Jiri Hudler out of position to make it 3-2 midway through the second period.
The Red Wings were scrambling to keep up with San Jose on the tying goal, as well, leaving Heatley alone in front for a shot that Howard couldn’t stop.
Detroit, though, made the big play in the heart-pounding final minutes to avoid elimination.
NOTES: Lidstrom’s first goal gave him 181 career playoff points, breaking a second-place tie with Ray Bourque for scoring by a defenseman, and broke an 11th-place tie overall with Jaromir Jagr.