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Background and Aims We present a case of a 67-year-old female with a history significant for a mechanical fall causing injury to her lumbar spine and pelvis resulting in hip and pelvic pain. Nine months after her injury, X-ray imaging demonstrated hypertrophic non-union of the right iliac wing fracture and displacement of pubic symphysis and right sacroiliac joint. She had pain in her low back, which radiated to the right lateral aspect of the buttock and groin, and pelvic pain. She was unable to consider surgery and her pain was not well managed with medications, thus she presented to the pain management clinic.
Methods The patient underwent diagnostic obturator and femoral articular nerve branch injections and she also a middle cluneal nerve steroid injection under fluoroscopic and ultrasound-guidance and reported improvement in her pain. She had a peripheral nerve stimulator (PNS) trial and subsequent implantation with leads to the right middle cluneal nerve and right obturator and femoral articular nerve branches.
Results The patient reported significant relief in both the posterior and anterior distribution of her pain. Her ADLs improved with PNS implantation and she reported that she is now able to sleep without pain.
Conclusions Through the use of combined fluoroscopy and ultrasound we were able to safely target the middle cluneal nerve and the obturator and femoral articular nerve branches. We were able to reliably replicate the patient’s pain distribution with neurostimulation before permanently implanting the PNS. This case demonstrates the successful use of PNS in treating chronic post-traumatic hip and pelvic pain.
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