Role of sacral ligament clamp in the pudendal neuropathy (pudendal canal syndrome): results of clamp release

Pudendal canal syndrome (PCS) is treated by pudendal canal (PC) decompression. We studied the hypothesis that failure of PCD to relieve anal and perianal pain could result from compression of the pudendal nerve (PN) not only in the PC but also in the sacral ligament clamp (SLC), i.e., in the space between sacrotuberous and sacrospinous ligaments. SLC release was performed in 21 patients with proctalgia who had not improved after PCD. PN terminal motor latency was higher than normal. The SLC release operation comprised entering the ischiorectal fossa through a para-anal incision, identifying the PN, and division of sacrospinous ligament. Treatment was successful in 17 patients and failed in 4. The former showed pain disappearance and improvement in fecal incontinence, perianal sensation, and anal reflex. Clinical manifestations and investigative results improved after SLC release in 80.9% of the cases. We assume that these results denote traumatization of the PN not only in the PC but also in the SLC.