Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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C. Ma and A. Ramaswamy
with no strong evidence for one predominant modality in terms of efficacy
[ 25 ]. Operative intervention is a viable option if spontaneous resolution
has not occurred by 1 year. Neurectomy and neuroma excision,
adhesiolysis, muscle or tendon repair, and foreign body removal are all
possibilities, with inconclusive evidence despite favorable reported outcomes
[ 26 ].
Secondary groin pain has also been reported in the literature after
surgery in orthopedic procedures involving the lumbar spine. Injury to
the lumbar plexus is a well-known complication of lateral lumbar interbody
fusion, a new and increasingly popular alternative for interbody
arthrodesis for degenerative spine disease that involves a lateral transpsoas
approach to the lumbar spine. Reported incidence in literature
ranges from 0.7 to 25 % [ 27 , 28 ]. Inconsistencies in defining postoperative
neurogenic injury and small sample size in the current literature
have contributed to this large variation. Operative time, inclusion of the
L4–L5 level, and use of recombinant human bone morphogenetic protein-2
(rhBMP- 2) have been identified as possible independent risk factors
for iatrogenic nerve injury [ 29 ].
Conclusion
A comprehensive history and physical exam is the first step toward
differentiating primary from secondary groin pain. Though an inguinal
hernia is the most common cause of groin pain, other causes include
sports hernia, referred hip pain, spermatic cord, and testicular causes,
and various gynecologic etiologies. Secondary inguinodynia after surgery
is also an increasingly recognized complication of inguinal and
spine surgery.
References
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23rd ed. London: Hodder Arnold; 2000.
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Hernia Database Collaboration, et al. Quality assessment of 26,304 herniorrhaphies in
Denmark: a prospective nationwide study. Lancet. 2001;358(9288):1124–8.
4. Diesen DL, Pappas TN. Sports hernias. Adv Surg. 2007;41:177–87.