Sciatica beyond the spine: a prospective study on laparoscopic neurolysis of pelvic sciatic and sacral nerves demonstrating long-term improvements in pain, function, mood, and bladder symptoms (VAS, SF-36, PHQ-9, OAB-V8)

Abstract

Background Intrapelvic entrapment of the sciatic and sacral nerve roots can cause chronic pelvic pain, sciatica, and symptoms such as dysmenorrhea, dyspareunia, dyschezia, dysuria, vulvodynia, coccygodynia, and pudendal neuralgia. Conventional spine-focused approaches often overlook this cause. This study assessed whether laparoscopic nerve decompression improves pain and related outcomes. Methods Between November 2022 and April 2024, 25 women (median age: 36 years) with >= 2 years of refractory pelvic neuropathic pain underwent laparoscopic decompression of the sciatic and sacral plexus. Diagnosis was confirmed via neuropelveological exam and 3-Tesla MRI. Patient-reported outcomes-Visual Analogue Scale (VAS) for nine pain domains, SF-36, PHQ-9, and OAB-V8-were collected preoperatively and at 1, 6, and 12 months postoperatively. Operative details and complications were recorded. Results All surgeries were completed laparoscopically with no conversions or motor deficits. Median operative time was 143.5 min. VAS scores decreased by 70-90% at one month (p <= 0.001) and remained improved at 6 and 12 months. SF-36 subscales improved significantly by month 1 and peaked at month 6. PHQ-9 dropped from 18.2 to 6.8 at 12 months (p < 0.001). OAB-V8 scores also showed significant improvement (p < 0.05). Conclusions Laparoscopic decompression of intrapelvic sciatic and sacral nerves appears safe and effective, providing substantial and sustained improvements in pain, quality of life, mood, and bladder symptoms. Further randomized trials are needed to validate these findings.