Pudendal Nerve Neurolysis

[paulette]

On Monday, May 16, I saw Dr. Hanson at the Centeno-Schultz clinic. He performed a pudendal nerve hydrodissection. or neurolysis. He injected saline and cortisone along the pathway of the pudendal nerve, starting at the ishial spine. He also injected the obturator internus and hydrolyzed some scar tissue at the sciatic nerve. He was able to view the nerves by use of a MSK ultrasound. The theory is that injecting the fluid pushes the tissue away from the nerve, allowing it time to shrink and heal. For the first time I had 90% pain relief, although I still had numbness in the rt. saddle area. I continue to have almost complete relief of buttock pain, although I still cannot sit. But that is reasonable, as the nerve needs to heal, just as in decompression surgery. I intend to go back and have more work done on the rt. side as well as the left. I would recommend this procedure to anyone having PN pain before resorting to surgery.

[helenlegs 11]

Hi Paulette,
That sounds fantastic. . . . I am so pleased it has helped you so much. It's not something I have heard about before, hopefully it will be something a lot of us will be able to take advantage of in the future. Thanks for the post.
(((hugs))) from Helen

[Karyn]

Oh, Paulette!!!! I'm sooooooooo very happy for you! How exciting!
Are you on a schedule for treatments? I know you mentioned going back again, but was wondering how many treatments you'd have to undergo to acheive a lasting effect? Are the treatments themselves painful?
You've just made my day, Paulette! Thanks for sharing the info and please keep us posted about your progress!
Love and hugs,
Karyn

[nyt]

This is just wonderful! I am so glad that you are that much improved and I certainly hope that you have lasting effects from this treatment.

How small of an incision does he make? How much water pressure does he have to use or dose he just insert a needle and forcefully push fluid into the area? I'm trying to figure out how different this would be from a nerve block other than he used saline instead of marcaine.

Keep us posted on how you are doing. If this ends of working just as good surgery this could be a big breakthrough.

[paulette]

Dr. Henson used saline and marcaine. It did not involve an incision, only a needle stick, only a lot more fluid is involved, which he injects with a syringe. He said I can come back for a second treatment, including the left side. He said if that doesn't heal me, he will use human growth factors, which poses a problem for me, because my insurance would not cover it. He said human growth factors heal the nerve. I know some physicians use Sarapin. I am going to try to talk him into using that drug. I have read up on it, and it doesn't seem to have any adverse effects and also promotes nerve healing. Yesterday I saw a PT who encouraged me to do some gentle ham strings and piriformis stretches. That was the wrong thing to do, as it inflamed the nerve and caused some of the buttock pain to return. But i am still hoping the pain will calm down.

I am also in touch with Dr. Hal Martin from Oklahoma City, who does pudendal decompression surgeries endoscopically. There is another surgeon in LA by the name of Nader Pouratian. He is a neurosurgeon who does pudendal decompression surgery, sometimes endoscopically, sometimes open surgery. It is exciting to see that there are more surgeons who are aware of this problem than we may have originally realized.

I hope I have answered everyone's questions.

[Violet M]

Paulette, so glad to hear you are feeling better. I would be interested to hear more about the approaches used by the two docs you mentioned -- Dr. Martin and Dr. Pouratian.

http://www.drhalmartin.com/pages/drmartin.htm

http://www.uclahealth.org/body.cfm?id=4 ... &ref=95328

You stated they perform surgery endoscopically -- do you know what is the point of entry for the surgery? Dr. Bautrant also uses an endoscope when performing the TIR approach.

I'm sure there are other physicians we don't know about who treat PNE and we always appreciate it when patients come back and relay their experiences to other forum members. How were you able to find out about these physicians?

[donstore]

Hi Paulette,
Great to hear you have found some relief. Please keep us posted on this new therapy. Also, any additonal info on the new docs. I know you were considering a 1.5T MRI with Dr. Potter due to the metal in your back. I will be seeing her on next Wednesday for the same due to the metal in my hip.

Best Wishes,

Don

[paulette]

Hi, Violet,
I do not know the point of entry for Dr. Martin's endoscopic surgery. I will probably fly to Oklahoma City for an exam. It is comparatively close to my home and cheap to fly there. His nurse said Dr. Martin checks all around the pelvis to find all possible sites of entrapment. I assumed she meant he explores with the endoscope, but i can't say that for sure. I did ask her if he cuts the SS ligament. She said he does not feel that is beneficial. In my case, I believe it would be. My pudendal nerve pain is worse since having my SI joint fused. I have come to realize the reason for the development of my PN pain is because my spine surgeon did not fuse my pelvis in a neutral position. He gave me an extreme lordosis, which has caused my muscles and ligaments to be pulled up and tight, compressing the pudendal nerve. Dr. Hanson said he could tell my nerve is not adhered to the sacrotuberous ligament. But he only treated 2 cm., so I imagine it could be entrapped elsewhere or at the OI, which is what Dr. Martin believes.

Dr. Pouratian required that I send him my records before even agreeing to see me. His nurse said after he sees me and determines whether I need decompression surgery, then we will discuss whether to use an open approach or endoscope approach. Again, I am hoping he is open to cutting the SS ligament. I have had piriformis injections, and I don't believe releasing the piriformis will benefit me. Hope this helps.

[paulette]

Hi, Don,
I was going to have a 3T MRI by Dr. Potter, but then I heard about Dr. Hal Martin and his ability to read the 3T MRI. I know of a woman who had a 3T MRI by Dr. Potter. When she read it, she missed an entrapment at the OI that Dr. Martin found. So I sent my 3t MRI that was done in Colorado to Dr. Martin in Oklahoma City. Dr. Pouratian at UCLA uses the MRN.

After the pudendal nerve neurolysis on Monday, I felt wonderful. As I stated above, I tried some stretches, which inflamed the nerve. I regret to report that much of the pain has returned but not all of it. I would like to try the procedure again, especially on the left side. I think my true problem is the fusion of my spine to the pelvis and an improper alignment of the pelvis. I don't even know if a pudendal nerve decompression surgery would resolve the problem. I need more room in my pelvis. If anyone has any ideas, I would love to hear them.

Violet, you asked me how I heard about the two surgeons I mentioned. I heard about them from a couple of women on the yahoo piriformiss forum.

[Violet M]

Thanks, Paulette -- what would we do without forums!?!?!?!

I'm sorry to hear your pain is back but it's possible having the procedure done may have helped to confirm that you have a nerve impingement somewhere along the pathway where he injected or distal to that, and that it's not a problem with the spinal/sacral area.