BACKGROUND: When pain resembles radiculopathy but remains intractable to a multitude of spinal procedures, alternative etiologies should be considered, including peripheral nerve entrapments. A rarely diagnosed neuropathy affects the posterior femoral cutaneous nerve (PFCN). While diagnosing this syndrome is uncommon, successful treatment can be a significant challenge depending on etiology.

CASE REPORT: We present the case of a 67-year-old woman with chronic, refractory left lower extremity radicular-type pain following multiple spinal surgeries and interventional procedures. A diagnostic evaluation ultimately identified the PFCN as the primary pain generator. Following successful diagnostic blockade and subsequent placement of a PFCN peripheral nerve stimulator, she achieved complete and durable pain relief for the first time in several years.

CONCLUSIONS: Our case highlights the importance of considering extraspinal neuropathic sources of pain in patients with unresolved radicular symptoms after spine-directed treatments.

KEYWORDS: Case report, peripheral nerve stimulation, posterior femoral cutaneous nerve