Peripheral nerve stimulation targeting the trochanteric branch of the femoral nerve for refractory greater trochanteric pain syndrome followed by dorsal root ganglion stimulation: A case report and mechanistic perspective.

INTRODUCTION: Greater trochanteric pain syndrome (GTPS) is a common cause of chronic lateral hip pain and may remain refractory despite pharmacologic therapy, physical therapy, and injection-based interventions. While radiofrequency ablation targeting the trochanteric branch of the femoral nerve has been described as a potential treatment, the use of peripheral nerve stimulation targeting this sensory branch remains limited.

CASE REPORT: We report a case of refractory GTPS in a 40-year-old woman treated with peripheral nerve stimulation (PNS) followed by dorsal root ganglion stimulation (DRG).

INTERVENTION AND OUTCOME: A temporary 60-day PNS system targeting the trochanteric branch of the femoral nerve resulted in complete resolution of hip pain during the treatment period. Following recurrence of lateral hip pain after lead removal, persistent longstanding low back and buttock pain prompted DRG stimulation to address the patient's broader preexisting pain distribution. Permanent implantation of right L1-L2 and bilateral S1 DRG leads resulted in approximately 75% reduction in both residual lumbosacral pain and recurrent lateral hip pain, with durable functional improvement.

CONCLUSION: This case highlights the trochanteric branch of the femoral nerve as a potential neuromodulation target for refractory GTPS. Peripheral nerve stimulation may provide a minimally invasive, targeted approach for lateral hip pain, while DRG stimulation may offer broader dermatomal coverage in patients with overlapping pain distributions. Further study is warranted.