Long-Term Treatment Results of Surgical Posterior Neurectomy in Patients With Anterior Cutaneous Nerve Entrapment Syndrome

Background The current step-up treatment approach for Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) involves tender point injections, pulsed radiofrequency, and surgical neurectomy. If anterior neurectomy fails or pain recurs, a secondary posterior neurectomy is considered as a final surgical option. We analyzed long-term treatment outcomes of a posterior neurectomy. Method All ACNES patients (2012–2022) who underwent unilateral posterior neurectomy received a questionnaire regarding their current pain status. Patients who not completed the questionnaire were excluded. Primary outcome was short- and long-term treatment success, defined as ≥50% pain relief. Based on the indication for posterior neurectomy patients were stratified: a. persistent pain and, b. recurrent pain (>3 months) after initial anterior neurectomy. Short-term outcomes were derived from medical records, long-term outcomes from the questionnaires. Results 258 of the 379 patients (68.1%) were included. Short-term outcomes were similar between in- and excluded patients, suggesting no selection bias. The recurrent pain group had significantly better treatment outcomes compared to the persistent pain group, in both short-term (7 weeks; treatment success 79.2% vs. 53.2%, p <0.001) as well as the long-term (58 months; treatment success 61.1% vs. 41.9%, p <0.001). Additionally, 24 of the 37 patients (64.9%) with recurrent pain after posterior neurectomy were again successfully treated. Fifteen (minor) complications (5.8%) were reported, resulting in three re-interventions (1.2%). Conclusion Posterior neurectomy shows favorable success rates (60%), especially for recurrent pain cases. Persistent pain after the first anterior neurectomy has significantly less successful results (40%). These data are helpful in proper patient counseling.