Introduction: Ilioinguinal neuralgia is an uncommon, but debilitating pain condition with many etiologies. Current treatment modalities include local corticosteroid infiltration, pulsed radiofrequency ablation, nerve decompression, neurectomy, peripheral nerve stimulation, and spinal cord stimulation, but outcomes after these interventions are frequently unsatisfactory. Dorsal root ganglion (DRG) stimulation is an emerging technique that may have a role in the treatment in many pain conditions. This case series reports on seven patients treated with (DRG) stimulation at a large academic tertiary referral center.
Methods: This case series includes all patients with chronic groin pain treated with DRG stimulation through 8/15/17 performed by one surgeon at a single site. Subjects were identified through departmental records and chart review. DRG stimulation was performed by the standard two-stage trial-implant technique. Subjects received a combination of T12, L1, and or L2, stimulation. Two subjects received bilateral stimulation. In the follow up period, subjects self-reported outcomes.
Results: Five of seven patients in this series had previously diagnosed ilioinguinal neuralgia. The two other subjects had less well defined chronic neuropathic penis and groin pain. Mean age at implant trial was 51.5 years old, and all subjects were male. Six subjects proceeded with permanent implantation after trial stimulation. At follow up, all six reported 80% or greater pain relief. One subject with atypical chronic penis pain failed a bilateral T12, L1 trial.
Conclusions: DRG stimulation is a promising technique for the treatment of ilioinguinal neuralgia and chronic neuropathic groin pain. Further investigation is warranted to be define the long-term effectiveness of this intervention amongst a wider ranger subjects and indications.
Patient Care: Ilioinguinal neuralgia and associated chronic neuropathic pains are devastating conditions that are difficult to treat. Dorsal root ganglion stimulation appears to be a valuable addition to the armamentarium against chronic pain. This case series is an introductory work, with the intention of instigating further, more definitive investigation of this promising treatment.
Learning Objectives: By the conclusion of this session, participants should be able to 1) consider the future role of DRG stimulation in ilioinguinal neuralgia and chronic neuropathic groin pain.