Endoscopic Sciatic Nerve Decompression After Fracture or Reconstructive Surgery of the Acetabulum in Comparison With Endoscopic Treatments in Idiopathic Deep Gluteal Syndrome

Park, Myung-sik; Jeong, Seong-Yep; Yoon, Sun Jung

doi:10.1097/jsm.0000000000000504

Cited by 11 publications

(23 citation statements)

References 15 publications

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“…Physical examination revealed recreation of buttock pain with one or more provocative tests, including Lasegue test; pace sign; flexion, adduction, internal rotation (FADIR) test; and seated piriformis test. Deterioration of motor function and foot drop were reported in a select group of patients after major trauma [27]. Plain radiographs, MRI examination, and diagnostic steroid injections were performed in all studies for preoperative assessment [12,[25][26][27].…”

Section: Presentation and Imaging Assessmentmentioning

confidence: 99%

“…Deterioration of motor function and foot drop were reported in a select group of patients after major trauma [27]. Plain radiographs, MRI examination, and diagnostic steroid injections were performed in all studies for preoperative assessment [12,[25][26][27]. The EMG-NCS were performed selectively to exclude spinal pathology and other peripheral compressive sciatic neuropathies [27].…”

Section: Presentation and Imaging Assessmentmentioning

confidence: 99%

“…Plain radiographs, MRI examination, and diagnostic steroid injections were performed in all studies for preoperative assessment [12,[25][26][27]. The EMG-NCS were performed selectively to exclude spinal pathology and other peripheral compressive sciatic neuropathies [27]. A summary of investigations, intraoperative particulars, outcomes, and complications are provided in Table 3.…”

Section: Presentation and Imaging Assessmentmentioning

confidence: 99%

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Endoscopic Sciatic Neurolysis for Deep Gluteal Syndrome: A Systematic Review

Metikala¹,

Sharma²

2022

Cureus

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Deep gluteal syndrome (DGS) is an underdiagnosed condition caused by an extra-spinal entrapment of the sciatic nerve in the deep gluteal space. Symptomatic patients who fail conservative treatment require surgical decompression of the nerve either by an open or endoscopic approach. In recent times, there has been an increasing trend towards minimally invasive surgery performed with endoscopic techniques. This systematic review aimed to assess the effectiveness of endoscopic sciatic nerve decompression in the management of DGS. A comprehensive search of the PubMed, Web of Science, Cumulated Index to Nursing and Allied Health Literature (CINAHL), and SPORTDiscus databases were performed on January 3, 2022. All English-language clinical studies on DGS treated with endoscopic surgical decompression were included. The initial search criteria identified 145 articles, of which four studies were available for the final review. There was one level III evidence, while the remaining three were level IV, comprising 144 patients with a mean age of 46 years. The Coleman methodology score (CMS) was utilized to assess the quality of the studies and the mean score was 62 (range, 52 to 71). The presence of fibrovascular bands and bursal tissue was the most common cause of DGS, followed by musculotendinous structures. The average follow-up of the included studies was 26.3 months (range, 12 to 32 months). Less favorable outcomes were seen in patients with major traumatic sciatic neuropathies after fractures or open reconstructive hip surgeries. Conversion to formal open surgery was recorded in one case of DGS caused by sciatic nerve schwannoma due to poor endoscopic access. One patient developed postoperative recurrent sciatic nerve entrapment due to a foreign body reaction requiring an open decompression. Overall, the available studies reported a high degree of clinical success with a low rate of complications, albeit no high-quality studies could be identified.

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Section: Presentation and Imaging Assessmentmentioning

confidence: 99%

Section: Presentation and Imaging Assessmentmentioning

confidence: 99%

Section: Presentation and Imaging Assessmentmentioning

confidence: 99%

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Endoscopic Sciatic Neurolysis for Deep Gluteal Syndrome: A Systematic Review

Metikala¹,

Sharma²

2022

Cureus

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“…Sciatic nerve decompression is performed by cauterizing fibrovascular scar bands via radiofrequency probes and removing with an arthroscopic shaver or dissection scissors (57,58). The tendinous portions of the piriformis may be split and the piriformis tendon may be released from its insertion on the greater trochanter using a radiofrequency hook probe and a retrograde technique (57,59).…”

Section: Surgical Techniquesmentioning

confidence: 99%

Surgical and Non-surgical Treatment Options for Piriformis Syndrome: A Literature Review

et al. 2021

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Context: Piriformis syndrome is a solely clinical diagnosis that often eludes the practitioner and goes underdiagnosed. PS is a pain syndrome and for those it affects, causes persistent pain and limits daily activity and work capacity. It is a form of deep gluteal syndrome that needs to be considered on the differential of low back pain as it comprises between 0.3% - 6% of all low back pain cases and is frequently underdiagnosed. Piriformis syndrome may be primary due anatomic anomalies or secondary, though the majority of cases are secondary to some insult. The objective of this manuscript is to provide a description of the epidemiology and presentation of piriformis as well as both non-operative and operative treatment options. We review all of the recent clinical evidence regarding the aforementioned therapies. Evidence Acquisition: Literature searches were performed using the below MeSH Terms using Mendeley version 1.19.4. Search fields were varied until further searches revealed no new articles. All articles were screened by title and abstract. Decision was made to include an article based on its relevance and the list of final articles was approved three of the authors. This included reading the entirety of the article. Any question regarding the inclusion of an article was discussed by all authors until an agreement was reached. Results: Medical management and physical therapy show some promise; however, when conservative treatment fails minimally invasive methods such as steroid injections, botulinum toxin injections, dry needling are all efficacious and there is substantial clinical evidence regarding these therapies. In those patients in which minimally invasive techniques do not result in an adequate relief of pain and return of function, endoscopic release can be considered. Endoscopic release is far superior to open release of the piriformis syndrome given the higher success and lower rate of complications. Conclusions: Piriformis syndrome is an important differential diagnosis in the work up of lower back pain and should not be ruled out with proper examination and testing. Clinicians should consider medical management and conservative management in the initial treatment plan for piriformis syndrome. There are many options within the conservative management and the literature shows much promise regarding these. Physical therapy, steroid injections, botulinum toxin injections, and dry needling are all potentially effective therapies with few adverse effects. Surgical options remain as gold standard, but only when conservative management has failed and the symptoms are significant to affect daily living activities. Endoscopic decompression of the sciatic nerve with or without release of the piriformis muscle has a reported high likelihood of success and a low complication rate. Current literature supports the preference of the endoscopic approach over the open approach due to improved outcomes and decreased complications. Further research is to well define the metrics for the diagnosis of piriformis syndrome and may include a need to develop diagnostic criteria.

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“…2e5 Endoscopic surgical decompression of the sciatic nerve has been shown to result in significant improvements in patient-reported outcomes. 6,7 There is the peritrochanteric supine approach as well as the posterior approach to address DGS. Advantages of the posterior approach include the ability to treat hamstring pathology and ischial bursitis, allowing for more complete decompression of the sciatic nerve.…”

mentioning

confidence: 99%

Infected Hematoma After Endoscopic Sciatic Nerve Decompression

Bloom

Essilfie

Wolfert

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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We present a 24-year-old male who developed an infected hematoma that resulted in sciatic nerve injury after he underwent an endoscopic sciatic nerve decompression. He underwent urgent hematoma evacuation and cultures speciated as Salmonella. At 4 months' follow-up, the patient's nerve had improved motor and sensory function. This case highlights the importance of obtaining appropriate hemostasis at the end of an endoscopic sciatic nerve decompression.

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Endoscopic Sciatic Nerve Decompression After Fracture or Reconstructive Surgery of the Acetabulum in Comparison With Endoscopic Treatments in Idiopathic Deep Gluteal Syndrome

Abstract: Endoscopic release of the sciatic nerve after fractures or reconstructive surgeries could provide some improvements without complications. However, more favorable outcomes were observed in the idiopathic DGS group.

Cited by 11 publications

References 15 publications

Endoscopic Sciatic Neurolysis for Deep Gluteal Syndrome: A Systematic Review

Endoscopic Sciatic Neurolysis for Deep Gluteal Syndrome: A Systematic Review

Surgical and Non-surgical Treatment Options for Piriformis Syndrome: A Literature Review

Infected Hematoma After Endoscopic Sciatic Nerve Decompression

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