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. 2021 May 24;11(1):10820.
doi: 10.1038/s41598-021-90319-y.

Laparoscopic approach to refractory extraspinal sciatica and pudendal pain caused by intrapelvic nerve entrapment

Nucelio Lemos  1   2   3 , Corey Sermer  4 , Gustavo Fernandes  5 , Augusta Morgado-Ribeiro  5 , Andrea Rossos  4 , Zi Ying Zhao  4 , Manuel J B C Girão  5 , Philip Peng  6
Affiliations

Laparoscopic approach to refractory extraspinal sciatica and pudendal pain caused by intrapelvic nerve entrapment

Nucelio Lemos et al. Sci Rep. .

Abstract

Entrapments of the intrapelvic portions of the lumbosacral plexus are an important extraspinal cause of sciatica and pudendal neuralgia. They can be treated using Laparoscopic Neuronavigation (LANN), a minimally invasive technique that has set the foundations of an emerging field in Medicine-Neuropelveology. This retrospective-prospective study analyzes the outcomes of 63 patients treated with the LANN technique over a 10 year time period. One year after surgery, 78.3% of patients reported clinically relevant pain reduction, defined as ≥ 50% reduction in Numeric Rating Scale (NRS) score; these results were maintained for a mean follow up of 3.2 years. Preoperative chronic opioid use (≥ 4 months of ≥ 10 mg morphine equivalents/day) was a predictor of poor surgical outcome-clinically relevant pain reduction was observed in only 30.8% in this group of patients, compared to 91.5% in patients not regularly taking opioids preoperatively (p < 0.01). Perioperative complication rate was 20%. Our results indicate that the LANN technique is an effective and reproducible approach to relieve pain secondary to intrapelvic nerve entrapments and that preoperative chronic opioid therapy significantly reduces the likelihood of a successful surgical outcome. This study provides detailed information on perioperative complication and postoperative course, which is essential for patient consenting.

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Conflict of interest statement

Nucelio Lemos has also received speaker honoraria for one event promoted by Promedon Inc. in March 2020. Nucelio Lemos received research support from Medtronic Inc for a researcher initiated project, in the form of equipment donation for the study, which is not related to this publication. No honoraria was received. The other authors declare no competing interests.

Figures

Figure 1
Figure 1
Distribution of nerve entrapments locations: 35% in proximal S2/S3/S4 nerve roots, 25% in sciatic/lumbosacral, 18% in proximal pudendal/medial sciatic, 12% in S1/S2 nerve roots, 8% in Alcock’s canal level and 2% in obturator nerve entrapment.
Figure 2
Figure 2
The five etiologies of intrapelvic nerve entrapment: neoplastic (A), fibrotic (B), endometriotic (C), abnormal piriformis muscle bundle originating medially to the sacral foramina (D) and neurovascular conflict before (E) and after (F) decompression. SN sciatic nerve; PM pyriformis muscle; OIM obturator internus muscle; PSN pelvic splanchnic nerves; AV abnormal vein.
See this image and copyright information in PMC

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