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Neurosurgery:
doi: 10.1227/NEU.0b013e318260fd8f
Case Reports

Successful Treatment of Pudendal Neuralgia With Tricolumn Spinal Cord Stimulation: Case Report

Rigoard, Philippe MD, PhD*,#; Delmotte, Alexandre MD*; Moles, Alexis MD*; Hervochon, Rémi MD*; Vrignaud, Thomas MD*; Misbert, Lorraine MD; Lafay, Nicolas MD‡,§; D'Houtaud, Samuel MD*; Frasca, Denis MD; Guenot, Claude MD; Giot, Jean-Philippe MD; Diallo, Bakari MD; Bataille, Benoit MD, PhD*

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Abstract

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 using new-generation multicolumn 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 transcutaneous electrical nerve stimulation and was implanted with a 16-contact surgical lead at the level of conus medullaris, allowing multicolumn 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 scale scores, respectively), with an improvement in all quality of life domains and a reduction in drug consumption.

CONCLUSION: Spinal cord stimulation using a 16-contact lead may be a viable therapeutic option for patients with refractory PN for whom decompressive surgery is contraindicated.

ABBREVIATIONS: BMT, best medical treatment

DN4, Neuropathic Pain Diagnostic Questionnaire

DR, dorsal root

EQ, EuroQol

PN, pudendal neuralgia

SCS, spinal cord stimulation

TENS, transcutaneous electrical nerve stimulation

TT, tripolar transverse

VAS, visual analog scale

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