Health Organization for Pudendal Education

Does anyone know if Dr. Marvel performs PN decompression surgery? I thought Dr. Conway told me he does the modified TG approach.

Karyn, Dr. Marvel does PNE decompression surgery using the TG approach but I'm not sure which TG method he uses.

Karyn, I remember from the old forum someone went to him but didn't improve and I think had something bad happen to them but can't recall what... and I concluded he is no Marvel. But that was just one person...

To be honest I don't really understand how they are doing this. If the nerve is compressed by the ligaments how is it possible to free them without cutting them completely and just making a small slice in the ligaments? I am not saying they are doing anything wrong I just don't understand how they are doing it.

What I will say if you do have an entrapment at the ligament you have to do something to the ligaments to relieve the compression on the nerve.



I think what you're saying here, Charlie, is that by doing the decompression through the ST ligament in order to preserve it entirely, the nerve is decompressed from any tethering or fibrotic/scar tissue that may be around the nerve. But, if the compression was due to the mechanical action of one or both ligaments physically pressing down on them, they'll still remain. Correct? If transposition of the nerve is still done, then you're hoping that this plus the surgical decompressing was enough.

Dr. Bautrant told me that the ST ligament doesn't compress the nerve, but doctors cut it open just to visualize the nerve. Rather, the SS ligament is the one that provides the compression and the pull when you sit. The ST is just in the way of the surgical procedure's visualization process. Thus, the ST does not need to be cut to free the nerve, whereas usually the SS does need to be cut. Therefore, windowing the ST ligament via Antolak or Conway's new approach, assuming they do things correctly, could be fine and the nerve could still be freed as long as the SS ligament is cut through or partially cut where it is calcified. Make sense?

Put your index fingers together and make a T so your insides of your fingers are touching. That's your nerve against the SS ligament. There's no tension when you're standing. Now pull the fingers together against each other. That's what happens when you sit. Now imagine the lower one being cut through thoroughly. That's the SS ligament being freed, so when you pull your fingers, nothing tugs on the nerve. Now imagine above those fingers, place your thumb there. That's the ST ligament. It's just in the way of seeing them, but when you pull the fingers together, the thumb does not pull anything. It's just there.

Whoo...quite the heated thread I missed while I was away! Believe the sentiment's already been stated...PNE's already enough of an adversary for us to be getting caught up fighting each other like this! (I'm all for respectful debate, but c'mon now!!)

grerichm wrote:do you know who does that approach, other than dr marvel?

The only person doing it, as far as I know, is Dr. Beco in Belgium, who was directly mentored by Shafik (who passed away a few years ago). And I think there's one other guy in Switzerland, but haven't really heard anything about him (can't even remember his name actually).

Pelvis Stressly wrote: And I think there's one other guy in Switzerland, but haven't really heard anything about him (can't even remember his name actually).

I believe that was Dr. Spinoza, but I don't know of any forum members who have had treatment with him.

pianogal wrote:

Dr. Bautrant told me that the ST ligament doesn't compress the nerve, but doctors cut it open just to visualize the nerve. Rather, the SS ligament is the one that provides the compression and the pull when you sit. The ST is just in the way of the surgical procedure's visualization process. Thus, the ST does not need to be cut to free the nerve, whereas usually the SS does need to be cut. Therefore, windowing the ST ligament via Antolak or Conway's new approach, assuming they do things correctly, could be fine and the nerve could still be freed as long as the SS ligament is cut through or partially cut where it is calcified. Make sense?.

Hello pianogal, Not sure I understand above in bold? Thought mine looked fairly attached (or adheared to) to the STL material.
RR

Hello pianogal, Not sure I understand above in bold? Thought mine looked fairly attached (or adheared to) to the STL material.
RR

If there are adhesions gluing the nerve to the ST ligament, then yes, they need to be separated. However, unless the nerve is growing through the middle of the ST ligament anatomically through some abnormality, you could technically release that adhesion without cutting through the ST ligament. The ST ligament doesn't compress the nerve, the SS one does... however, if the nerve is glued to either ligament, obviously the nerve needs to be separated from that adhesion. Cutting a ligament is not necessary to release that adhesion. Does that make more sense? Mechanically, the only ligament that compresses is the SS ligament via the body mechanics as the pelvis changes from standing to seated. During the movement from standing to seated, the ST ligament lies behind the nerve and doesn't have a way to compress it at all. The only reason it is cut is for visualization purposes.

pianogal wrote:Karyn, I remember from the old forum someone went to him but didn't improve and I think had something bad happen to them but can't recall what... and I concluded he is no Marvel. But that was just one person...

PG, this was back when Dr. Marvel was doing the TIR approach that someone had gotten worse. Marvel then switched to the TG approach which he learned from Dr. James Campbell at Hopkins. Since he started doing the TG I've only heard one person report and they had a good experience and were improving the last time they posted.

pianogal wrote:

To be honest I don't really understand how they are doing this. If the nerve is compressed by the ligaments how is it possible to free them without cutting them completely and just making a small slice in the ligaments? I am not saying they are doing anything wrong I just don't understand how they are doing it.

What I will say if you do have an entrapment at the ligament you have to do something to the ligaments to relieve the compression on the nerve.



I think what you're saying here, Charlie, is that by doing the decompression through the ST ligament in order to preserve it entirely, the nerve is decompressed from any tethering or fibrotic/scar tissue that may be around the nerve. But, if the compression was due to the mechanical action of one or both ligaments physically pressing down on them, they'll still remain. Correct? If transposition of the nerve is still done, then you're hoping that this plus the surgical decompressing was enough.

Dr. Bautrant told me that the ST ligament doesn't compress the nerve, but doctors cut it open just to visualize the nerve. Rather, the SS ligament is the one that provides the compression and the pull when you sit. The ST is just in the way of the surgical procedure's visualization process. Thus, the ST does not need to be cut to free the nerve, whereas usually the SS does need to be cut. Therefore, windowing the ST ligament via Antolak or Conway's new approach, assuming they do things correctly, could be fine and the nerve could still be freed as long as the SS ligament is cut through or partially cut where it is calcified. Make sense?

Put your index fingers together and make a T so your insides of your fingers are touching. That's your nerve against the SS ligament. There's no tension when you're standing. Now pull the fingers together against each other. That's what happens when you sit. Now imagine the lower one being cut through thoroughly. That's the SS ligament being freed, so when you pull your fingers, nothing tugs on the nerve. Now imagine above those fingers, place your thumb there. That's the ST ligament. It's just in the way of seeing them, but when you pull the fingers together, the thumb does not pull anything. It's just there.

Thanks for the explanation Piano Girl. My only query is does n't 'windowing' just mean cutting through the ligaments?