Dr. Dellon's New Publication about PNE and Surgery Approach

[shawnmellis]

Dr. Dellon, who is one of the best Peripheral Nerve Surgeons in the U.S. at Johns Hopkins Hospital, talks about a lot of interesting new things regarding PNE, pelvic pain, diagnosis, and treatment in this new publication from his website, including other areas of nerve compression such as the cluneal nerve in the but, the dorsal nerve in the upper perineum, which I feel I am entrapped at in the Dorsal Nerve area. He also does not believe that neurawrap is not necessary and may be harmful, which Hibner uses for PNE surgery. He gives the surgery results for all of the major PNE Surgeons who have performed PNE surgeries. He also states that he believes that at least one of the ligaments must remain cut open in some way, such as in carpel tunnel surgery, tarsel tunnel surgery, some PNE surgeries, and others in order to prevent future scar tissue formation. Here is the link to his publication that you can download here http://dellon.com/ps/chapter12.pdf Some of this publication was taken from his lecture in 2010 at the International Pelvic Pain Society. Let me know if you have any thoughts on it after reading it. After reading it, I am not too sure about the neurawrap as far as if it is a good thing or not because according to him it appears that it can sometimes actually stay adhered to the nerve and can prevent gliding of the nerve, even after the normal time it is supposed to dissolve away. The only thing I really am confused about still is leaving the Sacrotuberous Ligament or Sacrospinous ligaments are cut without repairing them by suture, because I feel they may be very important in helping support the Saroilliac Joint and also because it may possibly lead to Sacroilliac Joint Dysfunction or Piriformis Syndrome because they help support the Piriformis muscle, and after hearing about some patients who have gotten these new problems after surgery in which the ligaments were cut. I'm not sure if he cuts only a part of the Sacrotuberous Ligament or the entire ligament in half for PNE Surgery. I'm still confused on the whole cutting of the ligaments without suture thing as I"m sure a lot of you are because I know some people have gotten SIJD and Piriformis Syndrom after getting these ligaments cut. If anybody has a publication or study to show that cutting these ligaments do lead to Piriformis Syndrome or Sacroillliac Joint Dysfunction, please post them here. Take care and let me know if you have any thoughts or comments.

[shawnmellis]

I'm still confused on the whole cutting of the ligaments without suture thing as I"m sure a lot of you are. If anybody has a publication or study to show that cutting these ligaments do lead to Piriformis Syndrome or Sacroillliac Joint Dysfunction, please post them here. I've been only to so far find information that shows that these ligaments support the Sacroiliac Joint and Piriformis Muscle Here is one thing I found here at
http://en.wikipedia.org/wiki/Pelvis
The most important accessory ligaments of the sacroiliac joint are the sacrospinous and sacrotuberous ligaments which stabilize the hip bone on the sacrum and prevent the promonotory from tilting forward. Additionally, these two ligaments transform the greater and lesser sciatic notches into the greater and lesser foramina, a pair of important pelvic openings

and also here:
I found a Study from Vleeming in 1989, linking the sacrotuberous ligament to being the important ligament is stabilization of the SI joint and that without the sacrotuberous ligament's support that you can have Piriformis Syndrome and Sacro Iliac Joint Dysfunction. The website for this article is http://www.sidysfunction.com/generalinfo.php and here is what is says below:

The piriformis muscle, like the gluteus maximus, originates from the sacrotuberous ligament (Vleeming et al., 1989). It runs from the front of the sacrum to the femur and its action is to outwardly rotate the femur. It is a stabilizer of the SI joint via the sacrotuberous ligament. It is often the source of deep buttock pain associated with a sacroiliac dysfunction.

[nyt]

Go to the link below. At the top it says "All Databases". Change it to "Pubmed". Then type in Vleeming and hit enter. It will bring up all the publications by anyone with the last name of Vleeming over the last maybe 30 years. You can scroll through, read titles and abstracts. Some publications will be free.

http://www.ncbi.nlm.nih.gov/

I do wish Dr. Dellon had presented the literature by Vleeming as his publications demonstrate to me the importance of the the ST ligament.

Dr. Hibner told me that Loretta can tell the difference in patients SIJ who have had their ligaments cut as there is more mobility.

[Karyn]

Based on this model of the Pelvis and Ligaments - rear view, I don't understand how some form of pelvic instability could not occur by having these ligaments severed. Look at the points of attachment:

http://www.pudendalhope.org/node/13#Pel ... _Rear_View

[shawnmellis]

I also know of actual patients myself including an actual doctor who had PNE surgery and had one of his ligaments cut, that now have pelvic floor instability, Sacroiliac Joint Dysfunction, or Piriformis Syndrome. The pelvis is subjected to more stress than any other body structure and supports more weight than any other body part, so to me every ligament involved in supporting the pelvis is very important, especially the sacrotuberous ligament which is larger than the sacrospinous ligament.

[shawnmellis]

Hi guys and gals, I just wanted to also just say one last thing regarding this Dellon publication I posted. As far as Pudendal Nerve Surgeries (Not Dorsal) but typical Transgluteal Pudendal (alcocks, rectal branch, etc), he has not done a whole lot of these surgeries so far, so we need to hear more feedback on his success rates for pudendal surgery. Hibner has done more of the transgluteal surgeries than most surgeons in the US and his results should be out this year. Dellon is pretty much the only one besides Aszmann doing dorsal surgery or cluneal nerve surgery at this time and they both have good success rates for that although Aszmann has done more of those. Take care.

[Celeste]

Hibner has done more of the transgluteal surgeries than most surgeons in the US

I'd like to know more about how you arrived at this statement. Do you have results for all of the PNE surgeons?

[shawnmellis]

Hi Celeste, First of all, let me say I am glad that you are cured and you are trying to help PNE sufferers as I am. I said most, not all PNE surgeries have been done in the U.S by Hibner. Yes, of course Dr. Ansell in Houston has done the most in the U.S. I am glad you were cured from your surgery in Houston with Dr. Ansell, however your case is very rare and different from most cases of people with PNE. From what I understand your Sacrotuberous Ligaments and Sacrospinous Ligaments were found to be joined together, which was causing the compression. This is not the case for most people with PNE, so that is why it was necessary to separate those two ligaments. I"m not sure if they completely severed your ligaments or just separated the two ligaments from each other. Correct me if I am wrong on that. For most people with PNE, the two ligaments are not actually fused together, so it is caused by scar tissue or an inflamed, irritated nerve, or also by compression of the nerve between the two ligaments. Dr. Hibner removes any scar tissue around the nerve, and moves the nerve out of the area of compression and sutures back together the ligaments after he is done. If you talk with some of the patients who have had their ligaments cut and not sutured back together by some PNE surgeons, that they do have SIJD or Piriformis Syndrome directly after the surgery. I actually know an actual doctor who has pelvic floor instability himself after having his ligaments cut. Also, there are publications and evidence which I included above stating why the Sacrotuberous Ligaments and Sacrospinous Ligaments are indeed very important for preventing any different and further problems such as SIJD and Piriformis Syndrome. I wish that all surgeons would do a study to follow up with their patients after surgery to see if they have SIJD or Piriformis Syndrome after having their ligaments cut because there is research and publications stated above in my previous posts, which show the lack of support from these ligaments can cause this and also patients who have had their ligaments cut without repair have developed these new problems. Here is one survey showing this. We need one from the Houston and Robert team who have so far not done any to my knowledge.
http://tipna.org/forum/viewtopic.php?f= ... 40&start=0 As far as the results of all the surgeons, I do not have the results, but if you look at the publication by Dellon I posted he does list the results that he found somehow of the different PNE surgeons. Dr Hibner is supposed to have a new study published this year showing his results from his surgeries so far. Take care and There's Always Hope.
Shawn

[Celeste]

"I said most, not all PNE surgeries have been done in the U.S by Hibner. Yes, of course Dr. Ansell in Houston has done the most in Houston. I am glad you were cured from your surgery in Houston with Dr. Ansell, however your case is very rare and different from most cases of people with PNE."

That's crazy talk, "most in the US have been done by Hibner, Ansell has done the most in Houston". Do you not think Houston is in the US????? Ansell has done more than Hibner, period. Accept it.

If you actually talk to a surgeon, they'll tell you that there are a variety of physical abnormalities that can cause the entrapment. Calling out the one I had as if it's so rare as to make my case not be bona fide is just foolish. If it can happen to one person, it can happen to others.

These doctors are making changes to the surgery and patients are accepting that it's being done because there's a reason and that it's good. It's a leap of faith and there is no proof beforehand. Maybe some proof will come of it, maybe not. You seriously overestimate that and in my opinion, it doesn't help patients.

[shawnmellis]

Hi Celeste, that one statement, was a mistake and I have changed it. I meant to say that of course Ansell has done the most in the U.S. and not Houston or Texas. What about any studies showing SIJD or Piriformis ever done by the Houston team? This would be very important to do. Wouldn't you think? If it is not a problem, then why are many other surgeons now suturing back together these ligaments such as Hibner? I also want improvements in the way surgery is done for PNE as I'm sure you do, but you can not ignore what patients say about having these two things SIJD or Piriformis just because you did not get it.
Shawn