Laparoscopic Relief for persistent Extraspinal Sciatica
and pudendal pain from Pelvic Nerve Entrapment
Sciatica and pudendal neuralgia can result from entrapments of the intrapelvic portion of the lumbosacral plexus. These nerve entrapments cause pain and dysfunction in the lower limb, perineum, and gluteal regions, along with various associated symptoms.
The development of the Laparoscopic Neuronavigation (LANN) technique brought about significant advancements in diagnosing and treating intrapelvic nerve entrapments (INEs).
This minimally invasive approach allows for the successful dissection and release of intrapelvic nerves, resulting in improved clinical outcomes for patients. The LANN technique has also contributed to the emergence of Neuropelveology as a new medical field.
While it is widely recognized that a significant portion of the lumbosacral plexus is situated within the abdominal cavity, existing literature predominantly focuses on lesions occurring outside the abdomen, such as in the spine or deep gluteal space.
Intrapelvic entrapments of the plexus, on the other hand, have traditionally been limited to isolated case reports, with relatively limited coverage in research literature.
Intrapelvic nerve entrapments (INEs) are currently not well understood and often overlooked as potential causes of sciatica and pudendal neuralgia. The deep retroperitoneal location of the lumbosacral plexus requires laparoscopy for effective examination, but there is a knowledge gap due to the lack of training programs that integrate both laparoscopic and peripheral nerve surgery skills.
The Laparoscopic Neuronavigation (LANN) technique, introduced in 2004, revolutionized access to the intrapelvic region of the lumbosacral plexus in a safe and minimally invasive manner.
This breakthrough technique paved the way for the emergence of Neuropelveology as a new and pioneering field in medicine.
Initially designed for nerve-sparing procedures in cervical cancer and endometriosis surgeries, the Laparoscopic Neuronavigation (LANN) technique has been adapted as a minimally invasive method for relieving pain caused by intrapelvic nerve entrapments (INEs).
This surgical approach follows principles employed in successful treatments of other peripheral nerve entrapment syndromes, aiming to significantly reduce or eliminate pain associated with INEs.
Studies reported by literature have shown that laparoscopic nerve decompression is effective in reducing pain associated with peripheral nerve entrapment syndromes. Patients with conditions such as Alcock’s canal syndrome, endopelvic lesions, and endometriosis have experienced significant pain reduction.
Other studies have reported similar positive outcomes in patients with lumbosacral entrapment. This case series demonstrates the reproducibility of the Neuropelveological approach for intrapelvic nerve entrapments (INEs) and highlights the negative impact of chronic opioid use on long-term outcomes.
The study provides valuable insights into the locations of entrapments and emphasizes the importance of considering alternative sites for pudendal nerve entrapments. Awareness of combined symptoms can aid in the differential diagnosis of INEs at the sacral nerve roots.
Substantial delay in diagnosing intrapelvic nerve entrapments (INEs) has been reported, with patients enduring symptoms for an average of 4.7 years and undergoing unsuccessful surgeries.
This highlights the lack of awareness surrounding INEs as a potential cause of sciatica and pudendal pain. Similar delays have been observed in European cohorts, emphasizing the need for increased recognition and understanding of INEs.
The extended period of time between diagnosing intrapelvic nerve entrapments (INEs) and undergoing entrapment procedures can have a detrimental effect on success rates.
It has been discovered a greater likelihood of failure in LANN decompression when surgery was postponed for more than 2 years after the onset of symptoms, aligning with similar findings in previous research.
Insufficient awareness of intrapelvic nerve entrapments (INEs) can lead to ineffective surgeries and prolonged treatment delays. As patients await treatment, they may experience heightened distress and resort to chronic opioid use. Notably, our study highlights the negative impact of chronic opioid use on the success of surgical outcomes.
The study reported by literature reveals valuable insights into the recovery process after LANN detrapment, demonstrating that post-decompression neuralgia is experienced by nearly half of the patients for an average duration of approximately 6 months, while temporary motor deficits are observed in around 25% of patients for about 3 months on average.
Future studies examining various factors such as sexual function, pain quality, bowel/bladder dysfunction, and psychosocial components will enhance our understanding of the outcomes of laparoscopic nerve entrapment surgery.
Longer follow-up periods will also shed light on the durability of surgical effects and the need for additional pain management. Our findings validate the Neuropelveology approach for diagnosing and treating INEs, emphasizing the importance of raising awareness about the negative impact of non-specific pain management opioids on surgical success.