Emily B wrote: Also, he claims to have a 90% success rate with his pudendal surgery. If that were true, his near-certain cure would be written up in medical journals and all other doctors would be copying his success.
Well, actually his procedure *is* published in respectable medical journals, along with details of how he reaches his figure of 87\% of patients experiencing improvement:
Neursurg. Focus vol. 26 E9 2009
"The good to excellent outcome rate
(improvement of ≥ 4 on the 10-point analog scale) was
68% at 3 months posttreatment and was sustained after 1
year of follow-up in 87% of those patients in whom 1-year
data were available. The improved success rate at 1 year
posttreatment relative to the rate at 3 months was attributable
to the slow, steady improvement after 3 months; e.g.,
patients reported 0–3 points improvement at 3 months but
> 4 points at 1 year."
He has an older paper (2008) as well, that lacks the 1 year follow up, but is otherwise pretty much identical in content.
Of course, he seems to neglect to mention exactly how many patients provided data at 1 year, which makes that 87\% a little suspect. Only in the medical field would that omission get through peer review, but such are the standards.
Don't get me wrong, I don't really object to your comments, but credit where credit is due -- Filler is one of the few MDs actively publishing and developing techniques in this field. True, Hibner has a recent (2010) article, but he really just rehashes the procedure of Robert et al. which, lets be honest, doesn't have a huge amount of statistics to back up its efficacy either. Moreover Filler's objections to the transgluteal approach (as stated in his paper), are fair and his method does remove the risks he cites, though perhaps at the expense of introducing others. As for other surgeons using Filler's approach -- the reality is that very few surgeons working on PNE have the training required to perform neuroplasty laproscopically in such a difficult area. Filler has those skills, so he uses them. Unfortunately, as no one will ever do a large scale controlled and blinded study on such a rare problem, we will never really have the data required to compare approaches and surgeons objectively.
As an aside, one of the most interesting aspects of the paper is Filler's claim that only $\approx 5\%$ of his patients had entrapments at the ischial spine -- where most PNE surgeons believe that the majority of entrapments occur. On the contrary, Filler claims that just under 80\% of his patients are entrapped in Alcock's canal on the medial surface of the obturator internus. If true, that's very interesting and is consistent with one of the original studies on this problem done back in 1988 that looked at high mileage cyclists.
