Successful treatment of pudendal neuralgia with tricolumn spinal cord stimulation:  case report.
BACKGROUND
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.


METHODS
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.


CONCLUSIONS
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.
Department of Neurosurgery, Poitiers University School of Medicine, Poitiers, France. p.rigoard@chu-poitiers.fr
Philippe
P
Rigoard
Alexandre
A
Delmotte
Alexis
A
Moles
Rémi
R
Hervochon
Thomas
T
Vrignaud
Lorraine
L
Misbert
Nicolas
N
Lafay
Samuel
S
Dʼhoutaud
Denis
D
Frasca
Claude
C
Guenot
Jean-Philippe
JP
Giot
Bakari
B
Diallo
Benoit
B
Bataille
D004567:Electrodes, Implanted; D006801:Humans; D008297:Male; D008875:Middle Aged; D060545:Pudendal Neuralgia / Q000628:therapy*; D062187:Spinal Cord Stimulation / Q000379:methods*