New surgical evolutions in management of sacral radiculopathies

Abstract

Neurophysiological investigations and neurosurgical procedures of the sacral plexus are not especially well developed, because the sacral plexus is difficult to access. Awareness that sacral radiculopathies may exist is still lacking and the incidence of these pathologies is widely underestimated. Since the recent introduction of laparoscopy in the field of pelvic nerves, the situation has changed considerably: laparoscopy not only permits a precise morphological and functional exploration of the entire sacral plexus, but also offers new therapeutic options: In lesions to the sacral nerve roots by compression, infiltration, or surgical damages, the laparoscopy offers an adequate access for micro-neurosurgical procedures; whereas in neurogenic pathologies or situations of failure of neurosurgical treatments, the technique of laparoscopic implantation of a neuroprosthesis - the LION procedure - permits the neuromodulation of all sacral nerve roots in different combination with only one electrode for simultaneous control of pelvic/lower limb pain and pelvic visceral dysfunctions. Regarding the dramatically increased incidence of sacral radiculopathies, especially secondary to pelvic prolaps surgeries by blind mesh-material implantation, this field of pathologies has to come in the focus of medical interests. Also, physicians involved in pelvic pathologies/surgeries have to be trained in clinical neuropelveology.