Clinical results of endoscopic sciatic nerve decompression for deep gluteal syndrome: mean 2-year follow-up

Abstract

BackgroundThe purpose of this study is to assess the effectiveness of endoscopic sciatic nerve decompression and evaluated the differences of clinical results between atraumatic and traumatic groups.MethodsSixty consecutive patients. We retrospectively reviewed sixty consecutive patients without major trauma (45 hips) or with major trauma (15 hips) groups to compare the outcomes of endoscopic treatment.). The mean follow-up period was 24 ± 2.6 months (range, 24–38.4 months).ResultsThe mean duration of symptoms was 14.1 months (range, 12 to 32 months). Compromising structures were piriformis muscle, fibrovascular bundles, and adhesion with scar tissues. The mean VAS score for pain decreased from 7.4 ± 1.5 to 2.6 ± 1.5 (P = .001). The mean mHHS increased from 81.7 ± 9.6 to 91.8 ± 7.6 (P = .003). Clinically, positive paresthesia and seated piriformis test were statistically significant to diagnosis sciatic entrapment syndrome. Paresthesia and sitting pain were significantly improved at the final follow-up (P = .002). More favorable outcome was observed a group without major trauma. No complication was observed.ConclusionsEndoscopic sciatic nerve decompression is a safe and effective procedure for the management of DGS. Patients with major trauma could have poor clinical outcome. Seated piriformis test, FADIR, and tenderness of sciatic notch are maybe useful guide for pre and postoperative evaluation of DGS.

A minimally invasive surgical approach for the treatment of piriformis syndrome: a case series

“…The benefits of this treatment method are that it allows for a minimally invasive surgical approach, which leads to a faster recovery and shorter hospital stay. Additionally, it has decreased morbidity as compared to the open procedure [14]. The significant limitation of the endoscopic approach is the very steep learning curve in the use of endoscopic equipment and arthroscopy before attempting this procedure.…”

“…The significant limitation of the endoscopic approach is the very steep learning curve in the use of endoscopic equipment and arthroscopy before attempting this procedure. Also, the approach provides significantly decreased visualization as compared to the open procedure and carries a higher risk of injury to local vasculature and nerves [1,14].…”

Arthroscopic Piriformis Release—A Technique for Sciatic Nerve Decompression

“…Although not commonly studied, there are 2 small studies that have evaluated the efficacy of piriformis release. Most recently, Park et al 11 evaluated the clinical outcomes of arthroscopic sciatic nerve decompression (n ¼ 60 hips). After a mean 24-month follow-up The piriformis is completely released off the piriformis fossa and the greater trochanter using electrocautery.…”

“…2,9,10 Although very few complications and satisfactory outcomes have been observed in previous studies, there is some concern that current techniques do not allow for an optimal visualization of the sciatic nerve. 10,11 Hence, it is imperative we continue to improve on existing techniques as well as develop new ones that may further optimize outcomes. Therefore, we aimed to describe an endoscopic technique for the release of the piriformis muscle in those with symptoms of sciatic nerve compression (Video 1).…”

Peripheral Nerve Entrapment and their Surgical Treatment

“…In the case of failure, surgical decompression removing the piriformis muscle or the offending fibrous band could be indicated [179,181] (Figures 13A-E). The results are inconsistent.…”