Spinal Cord at The Conus Medullaris For Treatment Refractory Pudendal

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Pudendal neuralgia is a neuropathic pain syndrome consisting of debilitating pain along the pudendal nerve distribution. Current evidence offers a variety of therapeutic options, however many patients demonstrate inadequate pain control. We present a 56 year old woman with an eight year history of left groin, vaginal, and rectal pain consistent with pudendal neuralgia. After failing physical therapy, pharmacologic therapy, and surgical intervention, a spinal cord stimulator was placed at the conus medullaris with subsequent 65% pain relief and improved sitting time. This report demonstrates spinal cord stimulation uniquely targeted to the conus medullari as an effective treatment modality for pudendal neuralgia.

The pudendal nerve is a mixed sensory and motor nerve originating from the ventral rami of S2-4 nerve roots. It exits through the greater sciatic foramen and enters the perineum via the lesser sciatic foramen and Alcock’s canal giving rise to three terminal branches; inferior rectal, perineal, and dorsal nerves. Collectively, these branches innervate the external anal sphincter, perianal skin and mucosa, muscles of the urogenital triangle, penis, clitoris, labia, and scrotum . Symptoms of pudendal neuralgia can be localized to any one, or all pudendal nerve distributions.

Treatment modalities for pudendal neuralgia are wide ranging, from conservative approaches involving physical therapy, medications, to surgery. Several interventional treatments, including direct peripheral nerve stimulation and spinal cord stimulation, may offer an alternative to pudendal nerve decompression, or treat remaining pain when surgery fails. At this time there is no consensus on the optimal management strategy, and many patients are left with inadequate relief.

Pudendal neuralgia is debilitating neuropathic pain syndrome associated with pain along the pudendal nerve distribution. Patients commonly present with a burning discomfort that is highly exacerbated by sitting. Other associated symptoms include paresthesias, allodynia, hyperalgesia, rectal or vaginal foreign body sensation, and dyspareunia . The nature of pudendal neuralgia in regard to its location and exacerbating factors, promotes a considerable loss of quality of life. There are a number of available treatments, including neuropathic pain medications and antispasmodics, physical therapy, perineural steroid injections, and surgical decompression.

Current Issue: Volume 3: Issue 1

Journal Submissions

Manuscripts including research articles, commentaries, and other reports will also be considered for publication and should be submitted either online or through mail.

You may submit your paper as an attachment at anesthesia[at]oajournal.org

Authors should prepare manuscript in accordance with the Journal's accepted practice.

Online Submission

Submit your Manuscript online or by mailing to us at: anesthesia [at]emedscience.org

Regards,                       
Elisha Marie,
Editorial Manager,
Anesthesiology Case Reports

Pudendal neuralgia is a neuropathic pain syndrome consisting of debilitating pain along the pudendal nerve distribution. Current evidence offers a variety of therapeutic options, however many patients demonstrate inadequate pain control. We present a 56 year old woman with an eight year history of left groin, vaginal, and rectal pain consistent with pudendal neuralgia. After failing physical therapy, pharmacologic therapy, and surgical intervention, a spinal cord stimulator was placed at the conus medullaris with subsequent 65% pain relief and improved sitting time. This report demonstrates spinal cord stimulation uniquely targeted to the conus medullari as an effective treatment modality for pudendal neuralgia.

The pudendal nerve is a mixed sensory and motor nerve originating from the ventral rami of S2-4 nerve roots. It exits through the greater sciatic foramen and enters the perineum via the lesser sciatic foramen and Alcock’s canal giving rise to three terminal branches; inferior rectal, perineal, and dorsal nerves. Collectively, these branches innervate the external anal sphincter, perianal skin and mucosa, muscles of the urogenital triangle, penis, clitoris, labia, and scrotum . Symptoms of pudendal neuralgia can be localized to any one, or all pudendal nerve distributions.

Treatment modalities for pudendal neuralgia are wide ranging, from conservative approaches involving physical therapy, medications, to surgery. Several interventional treatments, including direct peripheral nerve stimulation and spinal cord stimulation, may offer an alternative to pudendal nerve decompression, or treat remaining pain when surgery fails. At this time there is no consensus on the optimal management strategy, and many patients are left with inadequate relief.

Pudendal neuralgia is debilitating neuropathic pain syndrome associated with pain along the pudendal nerve distribution. Patients commonly present with a burning discomfort that is highly exacerbated by sitting. Other associated symptoms include paresthesias, allodynia, hyperalgesia, rectal or vaginal foreign body sensation, and dyspareunia . The nature of pudendal neuralgia in regard to its location and exacerbating factors, promotes a considerable loss of quality of life. There are a number of available treatments, including neuropathic pain medications and antispasmodics, physical therapy, perineural steroid injections, and surgical decompression.

Current Issue: Volume 3: Issue 1

Journal Submissions

Manuscripts including research articles, commentaries, and other reports will also be considered for publication and should be submitted either online or through mail.

You may submit your paper as an attachment at anesthesia[at]oajournal.org

Authors should prepare manuscript in accordance with the Journal's accepted practice.

Online Submission

Submit your Manuscript online or by mailing to us at: anesthesia [at]emedscience.org

Regards,                       
Elisha Marie,
Editorial Manager,
Anesthesiology Case Reports