Ahead of Print: Multi-column SCS in Pudendal Neuralgia
Background and Importance: There is large variation in the success of decompressive surgery for pudendal neuralgia (PN), the most chronic, disabling form of perineal pain. We attempt to determine whether spinal cord stimulation (SCS) using new generation multi-column leads could form part of the treatment algorithm for refractory PN.
Clinical Presentation: A man with PN that was unresponsive to conventional treatment demonstrated a neuropathic component, and had a negative response to nerve infiltrations (so he was not indicated for decompressive surgery) and a positive response to perianal TENS, and was implanted with a 16-contacts surgical lead at the level of conus medullaris, allowing multi-column stimulation. Using transverse combinations, it was possible to obtain 100% paresthesia over the perineal area without unwanted dorsal root stimulation. Perineal and radicular pain was successfully relieved for up to 12 months (80% and 60% reduction in the visual analogue scores, respectively), with an improvement in all quality of life domains and a reduction in drug consumption.
Conclusion: SCS using a 16-contacts lead may be a viable therapeutic option for patients with refractory PN who are contraindicated for decompressive surgery.
From: Successful Treatment of Pudendal Neuralgia with Tri-column Spinal Cord Stimulation: Case Report by Rigoard et al.