{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T18:43:36Z","timestamp":1793385816897,"version":"4.5.0"},"reference-count":81,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2023,1,12]],"date-time":"2023-01-12T00:00:00Z","timestamp":1673481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,14]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Persistent genital arousal disorder\/genitopelvic dysesthesia (PGAD\/GPD) is characterized by distressing, abnormal genitopelvic sensations, especially unwanted arousal. In a subgroup of patients with PGAD\/GPD, cauda equina Tarlov cyst\u2013induced sacral radiculopathy has been reported to trigger the disorder. In our evaluation of lumbosacral magnetic resonance images in patients with PGAD\/GPD and suspected sacral radiculopathy, some had no Tarlov cysts but showed lumbosacral disc annular tear pathology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>The aims were 2-fold: (1) to utilize a novel multidisciplinary step-care management algorithm designed to identify a subgroup of patients with PGAD\/GPD and lumbosacral annular tear\u2013induced sacral radiculopathy who could benefit from lumbar endoscopic spine surgery (LESS) and (2) to evaluate long-term safety and efficacy of LESS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Clinical data were collected on patients with PGAD\/GPD who underwent LESS between 2016 and 2020 with at least 1-year follow-up. LESS was indicated because all had lumbosacral annular tear\u2013induced sacral radiculopathy confirmed by our multidisciplinary management algorithm that included the following: step A, a detailed psychosocial and medical history; step B, noninvasive assessments for sacral radiculopathy; step C, targeted diagnostic transforaminal epidural spinal injections resulting in a temporary, clinically significant reduction of PGAD\/GPD symptoms; and step D, surgical intervention with LESS and postoperative follow-up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcomes<\/jats:title><jats:p>Treatment outcome was based on the validated Patient Global Impression of Improvement, measured at postoperative intervals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Our cohort included 15 cisgendered women and 5 cisgendered men (mean \u00b1 SD age, 40.3 \u00b1 16.8 years) with PGAD\/GPD who fulfilled the criteria of lumbosacral annular tear\u2013induced sacral radiculopathy based on our multidisciplinary management algorithm. Patients were followed for an average of 20\u00a0months (range, 12-37) post-LESS. Lumbosacral annular tear pathology was identified at multiple levels, the most common being L4-L5 and L5-S1. Twenty-two LESS procedures were performed in 20 patients. Overall, 80% (16\/20) reported improvement on the Patient Global Impression of Improvement; 65% (13\/20) reported improvement as much better or very much better. All patients were discharged the same day. There were no surgical complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Implications<\/jats:title><jats:p>Among the many recognized triggers for PGAD\/GPD, this subgroup exhibited lumbosacral annular tear\u2013induced sacral radiculopathy and experienced long-term alleviation of symptoms by LESS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Strengths and Limitations<\/jats:title><jats:p>Strengths include long-term post-surgical follow-up and demonstration that LESS effectively treats patients with PGAD\/GPD who have lumbosacral annular tear\u2013induced sacral radiculopathy, as established by a multidisciplinary step-care management algorithm. Limitations include the small study cohort and the unavailability of a clinical measure specific for PGAD\/GPD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>LESS is safe and effective in treating patients with PGAD\/GPD who are diagnosed with lumbosacral annular tear\u2013induced sacral radiculopathy.<\/jats:p><\/jats:sec>","DOI":"10.1093\/jsxmed\/qdac017","type":"journal-article","created":{"date-parts":[[2023,1,12]],"date-time":"2023-01-12T09:10:17Z","timestamp":1673514617000},"page":"210-223","source":"Crossref","is-referenced-by-count":18,"title":["Lumbar endoscopic spine surgery for persistent genital arousal disorder\/genitopelvic dysesthesia resulting from lumbosacral annular tear\u2013induced sacral radiculopathy"],"prefix":"10.1093","volume":"20","author":[{"given":"Choll W","family":"Kim","sequence":"first","affiliation":[{"name":"Excel Spine Center , San Diego, CA 92120 , United States"},{"name":"Alvarado Hospital , San Diego, CA 92120 , United 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