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Superior Hypogastric Plexus Radiofrequency Neurectomy MIPSI

MIPSI or Minimally invasive pain and spine interventions is a broad term which encompasses all the Non-invasive and minimally invasive interventions done by the interventional spine and pain physicians for myriad of conditions right from Musculo-skeletal disorders like back pain, neck pain, knee pain etc.

What is Superior Hypogastric Plexus and where is it situated?


Superior Hypogastric plexus is a plexus of nerves present at the level of lower 1/3rd of L5 vertebra and upper 1/3rd of S1 vertebra. It is a retro-peritoneal structure and lies just anterior to the bifurcation of abdominal aorta.

From this plexus sympathetic fibers are carried into the pelvis through right and left hypogastric nerves. They also contain parasympathetic fibers which arise from pelvic splanchnic nerves( S2-S4 ) and ascend from inferior hypogastric plexus.

What is the procedure of Superior Hypogastric Plexus Radiofrequency neurectomy?


Superior Hypogastric Plexus Radiofrequency neurectomy is an advanced procedure which involves the precise placement of the Radiofrequency needles at the level of L5 and S1 vertebrae junction at the antero- lateral aspects from both sides, identification of the plexus with the help of sensory and motor stimulation and then its targeted ablation using Radiofrequency current.

Whole procedure is done under local anaesthesia with some mild sedation. 

What are the Indications of Superior Hypogastric Plexus neurectomy?

  • Pelvic Complex Regional Pain Syndrome ( CRPS )
  • Chronic Pelvic pain
  • Cancer pain from pelvic structures like cancer cervix, uterine cancer
  • Endometriosis
  • Pelvic inflammatory disease

How Superior Hypogastric Plexus neurectomy MIPSI helps relief pain?


Superior Hypogastric Plexus Radiofrequency neurectomy mainly acts by 2 mechanisms:


Peripheral Wallerian degeneration of the nerve: Due to the application of Radiofrequency currents , the friction between the various tissue molecules generate thermal energy which burns the nerves and brings about what is called as conduction block. So these nerves stop conducting pain signals from the affected site towards the brain where pain stimulus is actually processed and patient feels immediate relief from pain.

Central neuromodulation: Chronic pain has a component of Central Sensitization where in there is amplification of the pain signals in the brain and patients experience pain even in the absence of any movements or painful stimulus. With application of Radiofrequency ablation there is modulation in these central neural circuitries and the central sensitization is abolished.

How early the beneficial effects can be seen?


Patient can start appreciating the effect of the procedure within 3-4 days and maximal effect is achieved over a period of 3-4 weeks.

How many times this procedure has to be repeated?


The effect of this procedure can last from about 6 months to few years, after which this procedure has to be repeated. During this pain free period patient becomes drug free and thus escapes from the side effects of these medications which occur due to prolonged use of the drugs.

Will I require hospitalization for this procedure?


Yes. Patient generally is hospitalized for a period of 24 hours post-procedure for observation.

To see how this procedure is done, click the below link