Health Organization for Pudendal Education

I find it very interesting that he wrote an article on chronic pelvic pain and published his results when he had only done 5 PN surgies in 2009. Sure 100% excellent recovery looks good but it was only 5 sugeries!

I find it interesting that he says the ST ligament is not necessary for pelvic stability but never states the ligament's origin and insertion. From the figures he uses it sure looks like it originates at the posterior inferior iliac spine (and I have found other sources to say this as well) and I would call the PIIS part of the pelvis. Some people may not have instability issues when it is severed but that doesnt mean its purpose isnt to help stabilize the pelvis.

I also fins it interesting that the lady in figure 12-36 on pg 369 found relief from ischial tuberosity pain using that cushion. I have pain near the ischial tuberosity and tried that exact cushion and it does nothing to take pressure off the ischial tuberosities. On page 327 He says the PN runs just inside the tuberosity and some sources say it runs within 2.5cm so why can't the PN cause ischial tuberosity pain?

Did anyone else find the figures that looked like they were photographed directly out of anatomy books and not labeled difficult to read?

My biggest concern after reading this chapter was the information on neurowrap. It made a pretty convincing case of it sometimes causing a problem rather than helping. Isn't Dr. Hibner using neurowrap? Any of the others?

Thanks for sharing this LottaNerve
Grace

Grace,
I had surgery with Dr. Hibner a year ago tomorrow! Aug 30, 2010.
So reading about the Neurawrap shook me up a little - but they say a picture is worth a thousand words,
so this was even worse. I HOPE this is not what happens to most people, but if I understand this correctly, this is what Dr. Dellon finds when he opens up a surgery that has been "wrapped"
I have pain in the buttock area where I had no pain before, so of course I wonder.
But I was very excited and happy to get the Neurawrap when Dr. Hibner did my surgery. You just never know! We are all learning. I heard that Dr. Hibner is using a liquid form of the wrap in combination with the regular wrap. Has anyone else heard of that?

Neuragen is considered a nerve conduit. Nerve conduits were first used back in 1880 to bridge the gap between peripheral nerves that had been severed to help with their guidance to rejoin and prevent neuromas. Over the last 130 years investigators have experimented with multiple types of materials as nerve conduits to determine the best material to be used.

After reading Dr. Dellon's publication I decided I needed to do my own research to see if I agreed with Dr. Dellon. So far this is what I have found.

1. Dr. Dellon published a couple of papers back in the early 1990's on the use of nerve conduits in peripheral nerve repair after the nerve had been severed. In these different publications he compared types of materials used, the biggest "gap" that could be succesfully repaired, outcome and complications. As long as the "gap" was small patients had good to excellent outcomes, was not dependent on type of material and there were NO complications. Maybe he has changed his mind since those publications 20 years ago.

2. There is a clinical trial with over 150 patients in 2009 in which Neuragen was used on but I have not been able to get my hands on the full publication yet to read. The next clinical trial I could find only had 8 patients with 9 nerves back in 2008. I quote directly from the abstract: "Bioresorption is complete which decreases the likelihood of interneural scarring. Also, NeuraGen is not associated with episodes of compression neuropathy reported with other rigid non biodegradable materials."

3. I am trying to find what other nerve conduits are available. There is one called "Axoguard Nerve Protector Wrap" by Axogen. I do not know what material this is made out of. Neuragen is made out of type I collagen which is very pliable. For me, I'm having a hard believing Dr. Dellon's pictures are Neuragen because of the characteristics of type I collagen. When I was still working we worked with a lab that made tubes for growing cells into arteries and muscles sheets and they used collagen.

Dr. HIbner has used Neuragen on my obturator nerves and my right pudendal nerve. Before the surgery on my left side I plan on completing my research of peer reviewed scientific literature and if I come to the conclusion that I think Neuragen can cause reentrapment or intergrate into the nerve then I will present this data to Dr. Hibner and request no Neuragen. Until then, the jury is still out for me.

Hi Nyt,

Very informative answer indeed!

Hi LottaNerve,


I can assure you that your pain in the butt isn't a result of a Neurawrap.It is probably coming from the severing of your Sacrospinous ligament which has probably created some sort of pelvic instability and shifted your sacrum.As you must be well aware,that Athena's mom sacrum shifted by 5 mm after her Sacrospinous ligament was severed and her pelvis is out of alignment and causing various issues on top of her nerve pain..Piriformis muscle syndrome is a common thing after patients have their SS ligament severed and their nerve transposed at ischial spine.Your pain could be anything ranging from SIJD,Piriformis muscle syndrome, tailbone pain etc.

Things could have been much worse if your Sacrotuberous ligament was also divided and not repaired or sutured back.That is the dilemma that all PNE patients face and that's why TG surgery isn't like any other surgery.

That is also the main reason that none of the Post-surgical patients can ever dream of playing any kind of sports in their respective lives except for swimming because of the missing or divided ligaments.

Secondly,Neuwrap isn't used by Professor Roger Robert of Nantes,Dr. Mansur Khalfellah(the French Algerian doctor and new prodigy of Professor Roger Robert),the Houston team etc but all have some sort of Pelvic instability and some sort of Butt pain that you are complaining of.Even patients from Dr. Bautrant who had partially their SS ligament cut have tailbone pain issues and 20% of his patients did develop Piriformis muscle syndrome.This is based on his stats of 600 surgeries that he has performed.

My main concern is developing secondary issues like Sacro-illiac Joint dysfunction,Piriformis muscle syndrome,tailbone pain and Penile numbness post- surgery.

All the best,
Ali

The whole debate over the severing of the ST and SS ligament will remain unresolved until there are studies done comparing normal subjects to patients who have had either one or both ligaments severed. For now, we must all depend on: 1) studies done on cadavers, 2) computer generated simulations of the pelvis, 3) the opinion of the dr. performing our pudendal surgery, and 4) our own conclusions.

I try to make my decisions based on peer reviewed scientific literature. However, we pudendal patients have to venture where there are still alot of unknowns and a work in progress so we must also depend on our physician's own clinical experience and observations. Unfortunately, much of medicine is based on the physician's own clinical experience and opinions but that is just how it works. Hopefully, in the near future there will be some clinical studies done to help accurately determine the number of patients who develop piriformis syndrome, SIJD or tailbone problems after severing of both or one of the ligaments and who might have a propensity to develop one of these complications based on their own anatomy. We all know that the female pelvis is NOT exactly like the male pelvis so is one sex more likely to develop one of these complications just because the difference in for example the articulation surface of the SI joint.

I would imagine that patients who develop these complications after surgery probably had some hint BEFORE surgery that there were problems. In my case I went into the surgery with piriformis syndrome and a tailbone the chiropractor was having to put in place every couple of weeks. If I had not done all the investigation before the surgery and wasn't well aware of the status of my pelvis before the surgery I could easily have blamed my tailbone problems on the surgery but that was not the case because I realized while working with the chiro before surgery that my tailbone was slipping. My MRI with Potter even showed that it isn't in quite the perfect location.

For me, logically it makes sense that severing of any of the ligaments could result in some type of pelvic instability but there are so many patients that don't develop any of these problems really raises questions for me regarding the importance of the ST and SS ligaments. I personally choose not to run the risk because I went into the surgery with piriformis syndrome and I didn't not want to run the risk of making my condition worse because of the loss of the ST ligament due to the fact the piriformis attaches to the ST ligament. For me, everyone of us on this forum can evaluate and make our own decisions what is best for our own care and I would never second guess anyone's reasoning for the surgical approach they choose, whether they want Neuragen wrap or not, and whether they decide to have the ligaments cut and repaired.

Faith wrote:Did anyone else find the figures that looked like they were photographed directly out of anatomy books and not labeled difficult to read?

Yes, I noticed that, too Faith. As well as the photos from Wikkipedia.

Faith wrote:I find it very interesting that he wrote an article on chronic pelvic pain and published his results when he had only done 5 PN surgies in 2009. Sure 100% excellent recovery looks good but it was only 5 sugeries!

I could be wrong, but I don't think these were actually PN decompressions.
In my opinion, Dr. Dellons publication doesn't have a whole lot to back itself up. I found a lot of glaring contradictions. It also seemed to me that he was boosting himself up at the expense of other surgeons who have actually been performing PN decompression surgery. He may be an excellent peripheral surgeon in regards to other areas of the body, but I think he's got a ways to go with the pelvis and the PN.