Sciatic Nerve Variants and the Piriformis Muscle: A Systematic Review and Meta-Analysis

Poutoglidou, Frideriki; Piagkou, Maria; Totlis, Trifon; Tzika, Maria; Natsis, Konstantinos

doi:10.7759/cureus.11531

Cited by 24 publications

(27 citation statements)

References 28 publications

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Section: General Techniques: Approaches To Nerves Sciatic Nerve (Sn)mentioning

confidence: 99%

“…As it traverses from the low back posteriorly to the lower limb through the greater sciatic foramen and progresses distally in the posterior thigh compartment, it splits into two branches (tibial nerve and common peroneal nerve) just before the popliteal fossa. 98 The SN and its divisions provide sensory innervation to the foot and lower extremity except for the medial leg and ankle which are supplied by the saphenous nerve.…”

Section: Summary Of Literaturementioning

confidence: 99%

See 1 more Smart Citation

Evidence-Based Clinical Guidelines from the American Society of Pain and Neuroscience for the Use of Implantable Peripheral Nerve Stimulation in the Treatment of Chronic Pain

Strand¹,

D’Souza²,

Hagedorn³

et al. 2022

JPR

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The objective of this peripheral nerve stimulation consensus guideline is to add to the current family of consensus practice guidelines and incorporate a systematic review process. The published literature was searched from relevant electronic databases, including PubMed, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science from database inception to March 29, 2021. Inclusion criteria encompassed studies that described peripheral nerve stimulation in patients in terms of clinical outcomes for various pain conditions, physiological mechanism of action, surgical technique, technique of placement, and adverse events. Twenty randomized controlled trials and 33 prospective observational studies were included in the systematic review process. There is Level I evidence supporting the efficacy of PNS for treatment of chronic migraine headaches via occipital nerve stimulation; chronic hemiplegic shoulder pain via stimulation of nerves innervating the trapezius, supraspinatus, and deltoid muscles; failed back surgery syndrome via subcutaneous peripheral field stimulation; and lower extremity neuropathic and lower extremity post-amputation pain. Evidence from current Level I studies combined with newer technologies facilitating less invasive and easier electrode placement make peripheral nerve stimulation an attractive alternative for managing patients with complex pain disorders. Peripheral nerve stimulation should be used judiciously as an adjunct for chronic and acute postoperative pain following adequate patient screening and positive diagnostic nerve block or stimulation trial.

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Section: General Techniques: Approaches To Nerves Sciatic Nerve (Sn)mentioning

confidence: 99%

Section: Summary Of Literaturementioning

confidence: 99%

Evidence-Based Clinical Guidelines from the American Society of Pain and Neuroscience for the Use of Implantable Peripheral Nerve Stimulation in the Treatment of Chronic Pain

Strand¹,

D’Souza²,

Hagedorn³

et al. 2022

JPR

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“…Barbosa et al [ 23 ] conducted a systematic review and showed that the most prevalent anatomical variation was that the common fibular nerve passed through the piriformis muscle fibers (33.3%) and pointed to a possible association of this condition with piriformis syndrome. Similarly, Poutoglidou and colleagues [ 24 ] wrote a comprehensive systematic review with a meta-analysis of the SN variants relative to the PM and compared those variants’ prevalence among different geographical populations with respect to gender and laterality, reporting that SN variants were more common among East Asians (with a 31% pooled prevalence of total variants), and no statistically significant differences with respect to gender and laterality.…”

Section: Discussionmentioning

confidence: 99%

Anatomical Variations of the Sciatic Nerve Exit from the Pelvis and Its Relationship with the Piriformis Muscle: A Cadaveric Study

Reynoso

Ramirez

Nurmukhametov

et al. 2022

Neurology International

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Background: The sciatic nerve (SN) is the widest nerve of the human body that exits the pelvis through the greater sciatic foramen, usually below the piriformis muscle (PM), and descends between the greater trochanter of the femur and ischial tuberosity of the pelvis to the knee. The aim of this paper is to examine and identify the SN variations in relation to the PM, its prevalence, pattern, and course. Methods: A prospective-descriptive cross-sectional study was carried out to determine the frequency of anatomical variations in the exit of the SN in relation with the PM in 20 anatomical bodies (corpses) of both genders, in equal numbers. Results: The dissection of 40 SNs in corpses of both sexes in equal numbers showed that the SN exited inferior to the PM in 37 lower limbs (92.5%); between the fascicles of the PM and inferior to the PM in two lower limbs (5%); and in one thigh, between the fascicles of the PM and superior to the PM (2.5%). Our study reported that the SN divides in its terminal branches more commonly in the proximal part of the popliteal fossa in 55% of cases, in the gluteal region in 35% of cases, and in the middle third of the thigh in 10% of cases. Conclusions: Anatomical variations of the SN in relation to the PM are challenging for the diagnostic and therapeutic procedure in many clinical and surgical cases. Rapid recognition of the SN changes makes surgical approaches more accurate and effective. Our study confirmed that the SN exits the pelvis most commonly below the PM, although some anatomical variations may occur.

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“…Until recent years, pseudo‐sciatica or localized pain in the buttock, with or without radiation to the thigh, has been related to sciatic entrapment at the level of the piriformis muscle (Piriformis syndrome) (Hopayian et al, 2010), especially when the sciatic nerve has a variant anatomy (Poutoglidou et al, 2020). Pećina (1979) found that in 6.15% of cases the nervus peroneus communis passes between the tendinous parts of the piriformis, and they considered this variation of practical significance for the development of “piriformis syndrome.” During internal rotation of the thigh, the piriformis is extended, and the tendons of the divided muscle are tightly pressed together, pinching the nerve between them.…”

Section: Discussionmentioning

confidence: 99%

“…Until recent years, pseudo-sciatica or localized pain in the buttock, with or without radiation to the thigh, has been related to sciatic entrapment at the level of the piriformis muscle (Piriformis syndrome) (Hopayian et al, 2010), especially when the sciatic nerve has a variant anatomy (Poutoglidou et al, 2020). Pe cina (1979) found that in 6.15%…”

Section: Discussionmentioning

confidence: 99%

Sciatic nerve movement in the deep gluteal space during hip rotations maneuvers

et al. 2021

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We hypothesize that the sciatic nerve in the subgluteal space has a specific behavior during internal and external coxofemoral rotation and during isometric contraction of the internal and external rotator muscles of the hip. In 58 healthy volunteers, sciatic nerve behavior was studied by ultrasound during passive internal and external hip rotation movements and during isometric contraction of internal and external rotators. Using MATLAB software, changes in nerve curvature at the beginning and end of each exercise were evaluated for longitudinal catches and axial movement for transverse catches. In the long axis, it was observed that during the passive internal rotation and during the isometric contraction of external rotators, the shape of the curve increased significantly while during the passive external rotation and the isometric contraction of the internal rotators the curvature flattened out. During passive movements in internal rotation, on the short axis, the nerve tended to move laterally and forward, while during external rotation the tendency of the nerve was to move toward a medial and backward position. During the isometric exercises, this displacement was less in the passive movements. Passive movements of hip rotation and isometric contraction of the muscles affect the sciatic nerve in the subgluteal space. Retrotrochanteric pain may be related to both the shear effect of the subgluteus muscles and the endoneural and mechanosensitive aggression to which the sciatic nerve is subjected.

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Sciatic Nerve Variants and the Piriformis Muscle: A Systematic Review and Meta-Analysis

Cited by 24 publications

References 28 publications

Evidence-Based Clinical Guidelines from the American Society of Pain and Neuroscience for the Use of Implantable Peripheral Nerve Stimulation in the Treatment of Chronic Pain

Evidence-Based Clinical Guidelines from the American Society of Pain and Neuroscience for the Use of Implantable Peripheral Nerve Stimulation in the Treatment of Chronic Pain

Anatomical Variations of the Sciatic Nerve Exit from the Pelvis and Its Relationship with the Piriformis Muscle: A Cadaveric Study

Sciatic nerve movement in the deep gluteal space during hip rotations maneuvers

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