Parkash Anishinder, Ghorayeb Joe H, Levy Isaiah, Upadhyay Aman, Srinivasan Suresh, Chauhan Gaurav
Department of Physical Medicine and Rehabilitation, Tower Health Reading Hospital/Drexel, University COM, 420 S 5th Ave, West Reading, PA, 19611, USA.
University of Medicine and Health Sciences, 275 7th Ave 26th Floor, New York, NY, 10001, USA.
Interv Pain Med. 2023 Mar 23;2(1):100245. doi: 10.1016/j.inpm.2023.100245. eCollection 2023 Mar.
Triple neurectomy (resection of Ilioinguinal, Iliohypogastric, and Genitofemoral nerves) is performed in cases of inguinal neuralgia, refractory to conservative management. However, this procedure comes with several adverse effects, including but not limited to ectopic afferent firing and tactile allodynia. In such a scenario, the inguinal pain can become chronic and debilitating and can be classified as chronic post-surgical pain. Spinal neuromodulation techniques have been employed for treating such refractory, intractable chronic groin, pelvic and abdominal pain. One such technique is dorsal root ganglion stimulation which is designed to manage difficult-to-treat chronic pain in specific areas of the lower body, such as the foot, knee, hip, or groin. The authors present a case in which the patient underwent a laparoscopic neurectomy of ilioinguinal, Iliohypogastric, and genitofemoral nerves that failed to resolve her pain-related symptoms. The patient presented to the authors' pain clinic with severe inguinal pain and allodynia, refractory to multiple analgesic agents. The patient underwent a successful trial and subsequent implant with ipsilateral dorsal root ganglion stimulation at L1& L2. At six months post-implant, the patient continues to report 80-90% improvement in her pain and physical function.
对于保守治疗无效的腹股沟神经痛患者，可进行三联神经切除术（切除髂腹股沟神经、髂腹下神经和生殖股神经）。然而，该手术会带来多种不良反应，包括但不限于异位传入神经放电和触觉异常性疼痛。在这种情况下，腹股沟疼痛可能会变成慢性且使人衰弱，可归类为慢性术后疼痛。脊髓神经调节技术已被用于治疗这种难治性、顽固性慢性腹股沟、盆腔和腹部疼痛。其中一种技术是背根神经节刺激，旨在治疗下半身特定区域（如足部、膝盖、髋部或腹股沟）难以治疗的慢性疼痛。作者报告了一例患者，该患者接受了腹腔镜下髂腹股沟神经、髂腹下神经和生殖股神经切除术，但未能缓解其疼痛相关症状。该患者因严重的腹股沟疼痛和异常性疼痛就诊于作者的疼痛诊所，多种镇痛药物治疗无效。患者成功进行了试验，并随后在L1和L2水平进行了同侧背根神经节刺激器植入。植入后六个月，患者仍报告疼痛和身体功能改善了80 - 90%。
