Surgical Management of Deep Gluteal Syndrome Causing Sciatic Nerve Entrapment: A Systematic Review

Kay, Jeffrey; de, Darren; Morrison, Laura; Fejtek, Emily; Simunovic, Nicole; Martin, Hal David; Ayeni, Olufemi R.

doi:10.1016/j.arthro.2017.06.041

Cited by 42 publications

(30 citation statements)

References 41 publications

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“…Decompression of the SN and piriformis muscle (PM) tenotomy have been proposed to treat DGS. They have shown good results at the 2-year follow-up in clinical se-ries (Kay et al, 2017). Arthroscopic treatment of DGS has shown similar results to open surgery in clinical series.…”

Section: Introductionmentioning

confidence: 85%

Anatomic Landmarks for a Safe Arthroscopic Approach to the Deep Gluteal Space: A Cadaveric Study

Capurro¹,

Tey²,

Monllau³

et al. 2021

Int. J. Morphol.

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Section: Introductionmentioning

confidence: 85%

Anatomic Landmarks for a Safe Arthroscopic Approach to the Deep Gluteal Space: A Cadaveric Study

Capurro¹,

Tey²,

Monllau³

et al. 2021

Int. J. Morphol.

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“…A systematic review examining the surgical management of DGS across 28 studies described the causes, surgical indications, patient-reported outcomes, and complications in patients with DGS. 7 Some studies revealed that women were more prevalent, while others indicated that men were more prevalent among patients with DGS. 19 , 28 , 32 Sex differences as a predictor of postoperative DGS are still conflicting.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Deep Gluteal Syndrome After Hip Arthroscopic Surgery

Uchida

Kizaki

Hirano

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Deep gluteal syndrome (DGS) is an uncommon source of buttock and groin pain, resulting from entrapment of the sciatic nerve in the deep gluteal space. The incidence and risk factors of postoperative DGS after primary hip arthroscopic surgery are currently unknown. Purpose: To investigate the incidence and risk factors of postoperative DGS after primary hip arthroscopic surgery. Study Design: Case-control study; Level of evidence, 3. Methods: This study reviewed 1167 patients who underwent arthroscopic surgery between 2010 and 2018 by a single surgeon at a single center in Japan. DGS was defined using the seated piriformis stretch test, active hamstring test, and evidence of a hypertrophic sciatic nerve on magnetic resonance imaging. Overall, 11 of 1167 patients were diagnosed with DGS postoperatively. The DGS group (n = 11) was compared with the non-DGS group (n = 1156). Patient age, sex, body mass index (BMI), generalized joint laxity (GJL; Beighton score >6), number of hip arthroscopic procedures, and radiographic parameters including lateral center-edge angle, Sharp angle, vertical center anterior angle, Tönnis angle, alpha angle, ischiofemoral distance, ischiofemoral space, and quadratus femoris space were compared. The prevalence of developmental dysplasia of the hip (DDH) and borderline DDH (BDDH) was also compared. Logistic regression analysis was conducted to identify potential predictors for a postoperative DGS diagnosis. Results: The incidence of postoperative DGS in our study was 0.9%. Female sex (male:female ratio: 0:11 in DGS group vs 568:588 in non-DGS group; P < .01), mean number of hip surgical procedures (1.8 ± 0.9 in DGS group vs 1.1 ± 0.4 in non-DGS group; P < .01), and GJL ( P < .01) were significantly higher in the DGS group, while the mean BMI was significantly lower in the DGS group (19.8 ± 1.8 vs 22.7 ± 3.6 kg/m2, respectively; P < .01). Radiographic parameters were not significantly different between groups. Logistic regression analysis revealed that female sex (odds ratio [OR], 22.0 [95% CI, 1.29-374.56]), multiple surgical procedures (OR, 7.8 [95% CI, 2.36-25.95]), GJL (OR, 40.9 [95% CI, 8.74-191.70]), lower BMI (OR, 0.77 [95% CI, 0.644-0.914]), and DDH/BDDH (OR, 18.1 [95% CI, 2.30-142.10]) were potential predictors of postoperative DGS. Conclusion: The incidence of postoperative DGS in our study was 0.9%. The predictors for postoperative DGS after hip arthroscopic surgery were female sex, GJL, multiple hip surgical procedures, and DDH/BDDH. Although hip arthroscopic surgery can provide favorable clinical outcomes, surgeons should be aware of the risk factors for DGS as a complication of hip arthroscopic surgery.

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“…Although deep gluteal syndrome and piriformis syndrome were considered synonymous in the past, it has since become clear that piriformis syndrome is just one of many different causes that may be responsible for sciatic nerve entrapment causing pain in the buttock. In fact, in only one-fourth of the patients in a systematic review was the piriformis found to be causing entrapment of the sciatic nerve intraoperatively [106].…”

Section: Etiologymentioning

confidence: 99%

“…Overall, 33 studies evaluating the surgical management (open and endoscopic) of deep gluteal syndrome were identified in the literature [106,110,123]. Outcomes were positive, with an improvement in pain at final follow-up.…”

Section: Deep Gluteal Syndrome Outcomesmentioning

confidence: 99%

Advanced Hip Arthroscopy: What’s New?

Marin-Peña

Bajwa

Papavasiliou

et al. 2020

ESSKA Instructional Course Lecture Book

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26 184 26.1 Arthroscopic Management of "Cam" Deformity Cam deformity treatment options include open surgical dislocation, direct anterior mini open approach, and arthroscopy [1-3]. The rates of good to excellent outcomes are comparable between open and arthroscopic techniques, although reported complications may be slightly less with arthroscopy [4-7]. The management of the femoral head-neck junction is one of the commonest arthroscopic hip procedures, and the 2018 UK Non Arthroplasty Hip Registry (http:// www.nahr.co.uk/) accounts for 89.4% of all femoral procedures performed. There are many published surgical variations of how to approach the cam in planning, portals, and use of fluoroscopy, and we believe as many anecdotal variations as the number of surgeons performing hip arthroscopy since every physician has their own tricks and routine [8-10]. We provide some basic principles where the surgeons can evolve their own routine (Table 26.1).

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Surgical Management of Deep Gluteal Syndrome Causing Sciatic Nerve Entrapment: A Systematic Review

Cited by 42 publications

References 41 publications

Anatomic Landmarks for a Safe Arthroscopic Approach to the Deep Gluteal Space: A Cadaveric Study

Anatomic Landmarks for a Safe Arthroscopic Approach to the Deep Gluteal Space: A Cadaveric Study

Postoperative Deep Gluteal Syndrome After Hip Arthroscopic Surgery

Advanced Hip Arthroscopy: What’s New?

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