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Elzeiny A, Giai Via R, Donis A, Erdmenger S, Giachino M, Aprato A, Massè A. Endoscopy for sciatic nerve entrapment in deep gluteal syndrome. A systematic review of literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2025; 35:223. [PMID: 40450109 DOI: 10.1007/s00590-025-04349-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Accepted: 05/12/2025] [Indexed: 06/03/2025]
Abstract
BACKGROUND Deep gluteal syndrome (DGS) involves pain in the buttocks due to entrapment of the sciatic nerve (SN) in the deep gluteal space. This condition can be caused by various structures within this space, such as muscles and fibrous bands, which often cause significant pain and mobility problems. Diagnosis is based on clinical evaluation, diagnostic imaging and nerve conduction studies. At the same time, treatment ranges from physical therapy to surgery, with endoscopic treatment gaining popularity due to its reduced invasiveness and fewer side effects. MATERIAL AND METHODS The systematic review was conducted in accordance with the guidelines established by the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The review involved an extensive search of five major databases: PubMed, Scopus, Embase, Medline and Cochrane. Articles that met the eligibility criteria were carefully evaluated according to predefined levels of evidence (LoE). Retrospective studies were specifically assessed using the Coleman Methodology Score (mCMS). This review was registered with the International Prospective Registry of Systematic Reviews (PROSPERO), ensuring the rigor and reliability of the study. RESULTS The review identified 7 studies involving 312 patients (316 hips) with a mean age of 46.8 years and a mean follow-up of 25.1 months. The diagnosis was based on clinical, radiological and injection test results. Initial conservative treatment failed in all cases, necessitating surgery. Endoscopic sciatic nerve release showed success rates between 70 and 100%. Complications were minimal, with a recurrence rate of 2.5%, and revision surgery was required in 1.6% of cases. Postoperative results indicated a significant improvement in pain and function. CONCLUSION Endoscopic treatment of sciatic nerve entrapment in DGS is effective and safe when physical therapy has failed. Surgery offers significant pain relief and improved function with low complication rates. Despite limitations such as the predominance of retrospective studies and variability in patient management, the results support using this minimally invasive approach. Further high-quality research is needed to validate these results and optimize treatment protocols.
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Belyak EA, Lazko FL, Sufianov AA, Paskhin DL, Prizov AP, Lazko MF, Sagdiev RK, Zagorodnij NV. Endoscopic Treatment of Deep Gluteal Syndrome: 3-Portal Technique. Arthrosc Tech 2024; 13:103052. [PMID: 39308567 PMCID: PMC11411350 DOI: 10.1016/j.eats.2024.103052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/10/2024] [Indexed: 09/25/2024] Open
Abstract
We describe all-endoscopic deep gluteal syndrome treatment and sciatic nerve decompression at the infrapiriformis space. Surgery is performed with the patient in the prone position with the usual arthroscopic instruments and pump. The first step includes performing placement of 2 initial portals (medial and median) without fluoroscopy in the area of the ischial tuberosity and conjoint tendon, as well as release in this area with a subsequent shift in the lateral direction. The second step includes performing placement of an additional lateral portal for instruments, switching the camera into the median portal, and visualizing the sciatic nerve and its decompression at the infrapiriformis space and upper part of the thigh area. The postoperative period includes early activation, immediate passive and active motion after surgery, and full weight bearing the day after surgery.
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Affiliation(s)
- Evgeniy Aleksandrovich Belyak
- Moscow State City Hospital in Honor of Buyanov V.M., Moscow, Russia
- Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Fjodor Leonidovich Lazko
- Moscow State City Hospital in Honor of Buyanov V.M., Moscow, Russia
- Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Albert Akramovich Sufianov
- Russian Academy of Sciences, Russia
- Department of Neurosurgery, I.M. Sechenov First State Medical University (Sechenov University), Moscow, Russia
- Educational and Scientific Institute of Neurosurgery, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
- Federal Center of Neurosurgery, Tyumen, Russia
| | | | - Aleksej Petrovich Prizov
- Moscow State City Hospital in Honor of Buyanov V.M., Moscow, Russia
- Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Maksim Fjodorovich Lazko
- Moscow State City Hospital in Honor of Buyanov V.M., Moscow, Russia
- Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Ranel Khamitovich Sagdiev
- Department of Neurosurgery, I.M. Sechenov First State Medical University (Sechenov University), Moscow, Russia
- Federal Center of Neurosurgery, Tyumen, Russia
| | - Nikolaj Vasil’evich Zagorodnij
- Russian Academy of Sciences, Russia
- Orthopedic Department, National Medical Research Center for Traumatology and Orthopedics Named After N.N. Priorov of the Ministry of Health of the Russian Federation (Federal State Budgetary Institution)
- Orthopedic Department, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
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Hopayian K, Mirzaei M, Shamsi M, Arab-Zozani M. A systematic review of conservative and surgical treatments for deep gluteal syndrome. J Bodyw Mov Ther 2023; 36:244-250. [PMID: 37949567 DOI: 10.1016/j.jbmt.2022.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 12/11/2022] [Indexed: 11/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Conservative and surgical treatments, are recommended as the primary treatment in the management of patients diagnosed with deep gluteal syndrome; but evidence supporting superiority of one treatment over another is lacking. The aim of this review is to systematically review the effectiveness of treatments. DATABASES AND DATA TREATMENT MEDLINE, EMBASE, Web of Science, Scopus, AMED, Cochrane Library (Central Register of Controlled Trials), and PEDro were screened (to 24 July 2019). Risk of bias of trials and surgical case series were assessed using the Cochrane risk of bias tool and Joanna Briggs Institute Critical appraisal checklists, respectively. Outcomes were reductions in pain or disability. For each outcome, the minimum clinically important difference (MCID) was calculated. A narrative synthesis was performed. RESULTS Out of 909 records, thirteen studies with 508 patients were included, eight RCTs with 336 patients and 5 case series with 172 patients. Conservative modalities were: infiltration into muscle of steroid, botulinum toxin, thiochilcoside and colchicine. There was one RCT and five case series of surgery. Only three trials reached an MCID in pain reduction for the intervention. The five surgical studies reached a before and after MCID. Only one study showed an MCID reduction in disability. The overall quality of evidence was low. CONCLUSION Given the low quality of evidence, no single conservative treatment can be recommended over another. Clinicians should follow general guidelines on the management of back pain and sciatica for first line treatment, namely physiotherapy. Surgery may have a place for chronic cases.
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Affiliation(s)
- Kevork Hopayian
- Centre for Primary Care and Population Health, University of Nicosia Medical School, Cyprus.
| | - Maryam Mirzaei
- Department of Physiotherapy, School of Rehabilitation Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - MohammadBagher Shamsi
- Department of Physiotherapy, School of Rehabilitation Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran.
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Sun G, Fu W, Li Q, Yin Y. Arthroscopic treatment of deep gluteal syndrome and the application value of high-frequency ultrasound. BMC Musculoskelet Disord 2023; 24:742. [PMID: 37726704 PMCID: PMC10507890 DOI: 10.1186/s12891-023-06863-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023] Open
Abstract
PURPOSE This study aimed to evaluate the efficacy of arthroscopic sciatic neurolysis for treating deep gluteal syndrome (DGS) and to analyse the application value of high-frequency ultrasound during perioperative period. METHODS Between June 2020 and February 2022, 30 patients with DGS who underwent failed conservative treatment were retrospectively analysed. Lateral arthroscopic exploration of the deep gluteal space and sciatic neurolysis were performed. In addition to pelvic X-ray, lumbar disc and hip magnetic resonance imaging (MRI), ultrasonography of the sciatic nerve was also performed in all patients. The visual analogue scale pain score (VAS), modified Harris hip score (mHHS) and Benson symptom-rating scale were used to evaluate the clinical efficacy. The correlation between preoperative sciatic nerve ultrasound and arthroscopic findings was analysed. RESULTS The median follow-up for these patients was 13 months (range,12-21 months). Preoperative ultrasonography showed precise morphological changes in 26 sciatic nerves of patients. The VAS score decreased from 5.0 (4.0, 6.0) preoperatively to 0.5 (0, 1.0) postoperatively (p < 0.001), and the mHHS increased from 64.0 (57.0, 67.0) preoperatively to 95.0 (93.0, 97.0) postoperatively (p < 0.001). The Benson symptom score was excellent in 15 cases, good in 12 cases, fair in 2 cases, poor in 1 case; thus, the score was excellent or good in 90% of the cases. Preoperative ultrasound diagnosis and intra-operative findings matched up in all cases. There were four cases of transient numbness in the posterior thigh. CONCLUSIONS Arthroscopic sciatic neurolysis is a safe and effective treatment option for DGS patients who fail conservative treatment. Ultrasound diagnosis matched the arthroscopic findings perfectly. Preoperative Doppler ultrasound can assist surgical decision-making, guide intraoperative release.
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Affiliation(s)
- Guanjun Sun
- Department of Orthopedics, West China Hospital, Sichuan University, Sichuan Province, Chengdu, 610041, China
- Department of Joint Surgery, Suining Central Hospital, Sichuan Province, Suining City, 629000, China
| | - Weili Fu
- Department of Orthopedics, West China Hospital, Sichuan University, Sichuan Province, Chengdu, 610041, China.
| | - Qingshan Li
- Department of Joint Surgery, Suining Central Hospital, Sichuan Province, Suining City, 629000, China
| | - Yi Yin
- Department of Joint Surgery, Suining Central Hospital, Sichuan Province, Suining City, 629000, China
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Parodi D, Villegas D, Escobar G, Bravo J, Tobar C. Deep Gluteal Pain Syndrome: Endoscopic Technique and Medium-Term Functional Outcomes. J Bone Joint Surg Am 2023; 105:762-770. [PMID: 36943908 DOI: 10.2106/jbjs.22.00394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Sciatic nerve entrapment is an entity that generates disabling pain, mainly when the patient is sitting on the involved side. According to some studies, the presence of fibrovascular bands has been described as the main cause of this pathology, and the sciatic nerve's decompression by endoscopic release has been described as an effective treatment generally associated with a piriformis tenotomy. The aim of this study was to present the medium-term functional results of endoscopic release of the sciatic nerve without resection of the piriformis tendon. METHODS This prospective, observational study included 57 patients who underwent an endoscopic operation for sciatic nerve entrapment between January 2014 and January 2019. In all cases, a detailed medical history was obtained and a physical examination and a functional evaluation were performed using the modified Harris hip score (mHHS), the 12-item International Hip Outcome Tool (iHOT-12), and the visual analog scale (VAS) for pain. All patients had pelvic radiographs and magnetic resonance imaging (MRI) scans of the hip on the involved side and underwent a prior evaluation by a spine surgeon. RESULTS This study included 20 male and 37 female patients with a mean age of 43.6 years (range, 24 to 88 years) and a mean follow-up of 22.7 months. The median mHHS improved from 59 to 85 points. The median iHOT-12 improved from 60 to 85 points. The median VAS decreased from 7 to 2. Postoperative complications occurred in 12% of patients: 1 patient with extensive symptomatic hematoma, 3 patients with hypoesthesia, and 3 patients with dysesthesia. CONCLUSIONS Endoscopic release of the sciatic nerve by resection of fibrovascular bands without piriformis tenotomy is a technique with good to excellent functional results comparable with those of techniques in the literature incorporating piriformis tenotomy. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Dante Parodi
- Department of Orthopaedic Surgery, Clínica RedSalud Providencia, Santiago, Chile
- Fundación Médica San Cristóbal, Santiago, Chile
| | - Diego Villegas
- Department of Orthopaedic Surgery, Clínica RedSalud Providencia, Santiago, Chile
- Department of Orthopaedic Surgery, Hospital Padre Hurtado, Santiago, Chile
| | - Gonzalo Escobar
- Department of Orthopaedic Surgery, Hospital Universitario Austral, Buenos Aires, Argentina
| | - José Bravo
- Orthopaedic Residency Program, Universidad del Desarrollo, Santiago, Chile
| | - Carlos Tobar
- Department of Orthopaedic Surgery, Clínica RedSalud Providencia, Santiago, Chile
- Fundación Médica San Cristóbal, Santiago, Chile
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Choi WK, Oh JS, Yoon SJ. Simultaneous laparoscopic and arthroscopic excision of a huge juxta-articular ganglionic cyst compressing the sciatic nerve: A case report. World J Clin Cases 2022; 10:9028-9035. [PMID: 36157671 PMCID: PMC9477037 DOI: 10.12998/wjcc.v10.i25.9028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/11/2022] [Accepted: 07/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A large ganglionic cyst extending from the hip joint to the intrapelvic cavity through the sciatic notch is a rare space-occupying lesion associated with compressive lower-extremity neuropathy. A cyst in the pelvic cavity compressing the intrapelvic-sciatic nerve is easily missed in the diagnostic process because it usually presents as atypical symptoms of an extraperitoneal-intrapelvic tumor. We present a case of a huge ganglionic cyst that was successfully excised laparoscopically and endoscopically by a gynecologist and an orthopedic surgeon.
CASE SUMMARY A 52-year-old woman visited our hospital complaining of pain and numbness in her left buttock while sitting. The pain began 3 years ago and worsened, while the numbness in the left lower extremity lasted 1 mo. She was diagnosed and unsuccessfully treated at several tertiary referral centers many years ago. Magnetic resonance imaging revealed a suspected paralabral cyst (5 cm × 5 cm × 4.6 cm) in the left hip joint, extending to the pelvic cavity through the greater sciatic notch. The CA-125 and CA19-9 tumor marker levels were within normal limits. However, the cyst was compressing the sciatic nerve. Accordingly, endoscopic and laparoscopic neural decompression and mass excision were performed simultaneously. A laparoscopic examination revealed a tennis-ball-sized cyst filled with gelatinous liquid, stretching deep into the hip joint. An excisional biopsy performed in the pelvic cavity and deep gluteal space confirmed the accumulation of ganglionic cysts from the hip joint into the extrapelvic intraperitoneal cavity.
CONCLUSION Intra- or extra- sciatic nerve-compressing lesion should be considered in cases of sitting pain radiating down the ipsilateral lower extremity. This large juxta-articular ganglionic cyst was successfully treated simultaneously using laparoscopy and arthroscopy.
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Affiliation(s)
- Won-Ku Choi
- Department of Obstetrics and Gynecology, Medical School, Jeonbuk National University, Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju 54907, South Korea
| | - Jong-Sung Oh
- Department of Orthopedic Surgery, Medical School, Jeonbuk National University, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, South Korea
| | - Sun-Jung Yoon
- Department of Orthopedic Surgery, Medical School, Jeonbuk National University, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, South Korea
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Vanermen F, Van Melkebeek J. Endoscopic Treatment of Piriformis Syndrome Results in a Significant Improvement in Pain Visual Analog Scale Scores. Arthrosc Sports Med Rehabil 2022; 4:e309-e314. [PMID: 35494270 PMCID: PMC9042772 DOI: 10.1016/j.asmr.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 10/08/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Frédérique Vanermen
- Address correspondence to Frédérique Vanermen, M.D., Emmanuel Vierinlaan 3.03 – 8300 Knokke – Belgium.
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Metikala S, Sharma V. Endoscopic Sciatic Neurolysis for Deep Gluteal Syndrome: A Systematic Review. Cureus 2022; 14:e23153. [PMID: 35444897 PMCID: PMC9010003 DOI: 10.7759/cureus.23153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/05/2022] Open
Abstract
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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Affiliation(s)
- Sreenivasulu Metikala
- Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Vivek Sharma
- Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, USA
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Trasolini NA, Rice M, Paul K, Nho SJ. Endoscopic Sciatic Neurolysis for Deep Gluteal Space Syndrome. VIDEO JOURNAL OF SPORTS MEDICINE 2022; 2:26350254211063213. [PMID: 40308467 PMCID: PMC11903540 DOI: 10.1177/26350254211063213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/14/2021] [Indexed: 05/02/2025]
Abstract
Background Deep gluteal syndrome (DGS) encompasses a spectrum of pathologies causing symptomatic sciatic nerve compression deep to the gluteus maximus muscle. Endoscopic sciatic neurolysis is an option for management of DGS when conservative treatment fails. Indications Endoscopic sciatic neurolysis is indicated for retro-trochanteric pain, sciatica-like burning in the posterior thigh, and sitting discomfort that is reproducible on physical examination after failing conservative management. Technical Description The technique presented here introduces a standard endoscopic sciatic neurolysis technique with an accessory posterolateral portal placed distally and in line with the sciatic nerve. Use of a switching stick through an accessory distal posterolateral portal can allow for in-line protection and retraction of the sciatic nerve while it is carefully released from compressive fibrous bands using an arthroscopic shaver. It is important that the accessory portal be placed under direct visualization with caution not to injure the sciatic nerve. An arthroscopic radiofrequency device can be used for hemostasis and further release of fibrous bands. At the end of the procedure, the sciatic nerve should be visualized fully released and freely mobile from the piriformis muscle to the level of the lesser trochanter. Results In properly selected patients, the procedure is very successful. In a series of 35 cases, the procedure reduced sitting pain (present in 97% of patients preoperative, 17% of patients postoperative), reduced narcotic use, improved visual analog scale (VAS) pain scores, and improved modified Harris hip scores without major complications. Discussion Although rare following hip arthroscopy, postoperative scarring and fibrous bands are a common cause of DGS which can be effectively treated by endoscopic sciatic nerve decompression. Results of endoscopic sciatic neurolysis have thus far been encouraging with improvements in patient reported outcome scores and high rates of satisfaction. However, complications do occur and can result in neurologic deficits. Nevertheless, with careful patient selection and meticulous sciatic nerve dissection, endoscopic sciatic neurolysis for DGS is a safe and effective technique for decompression of fibrous bands and adhesions that can lead to sciatic neuralgia.
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Affiliation(s)
- Nicholas A. Trasolini
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Morgan Rice
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Katlynn Paul
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J. Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
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Hsieh TC, Hsu CW. Foreign body reaction mimicking local recurrence from polyactide adhesion barrier film after laparoscopic colorectal cancer surgery: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e28692. [PMID: 35119013 PMCID: PMC8812642 DOI: 10.1097/md.0000000000028692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 01/05/2022] [Indexed: 01/04/2023] Open
Abstract
Polyactide (PLA) barrier is one of the most commonly used materials to prevent the formation of postoperative adhesion. Even though previous studies supported the anti-adhesion efficacy of PLA barrier, there have been limited reports focusing on the associated foreign body reaction. We sought to investigate the potential complication of PLA barrier placement that could lead to unnecessary intervention.This is a retrospective study of colorectal cancer patients with laparoscopic surgery. Cases with stage IV unresectable disease, poor Eastern Cooperative Oncology Group Performance, death within 3 months after the surgery, and insufficient record were excluded. A total of 296 cases were identified in our study and 220 patients received PLA film placement. We compared the incidence of foreign body reaction between the patients with and without PLA film.Among PLA film group, 16 cases had signs of local recurrence on the follow-up image studies. The subsequent operation found 10 patients had no cancerous lesions but only foreign-body-associated granulomas. The incidence of foreign body reaction mimicking local recurrence on image study was 4.5% with high false positive rate of 62.5% on positron emission tomography scan in patients with PLA film. There were only 2 cases without the antiadhesive barrier developed signs of recurrence during active surveillance. Both cases were later confirmed to have malignant peritoneal seeding.The PLA film was associated with rare foreign body reaction that could interfere the accuracy of follow-up program and result in unnecessary surgical intervention. Hence, we recommend avoiding the use of the PLA barrier.
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Affiliation(s)
- Tien-Chan Hsieh
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, Taiwan
- Department of Medicine, Danbury Hospital, 24 Hospital Avenue, Danbury, CT
- Department of Internal Medicine, Yale University, 333 Cedar St, New Haven, CT
| | - Chao-Wen Hsu
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, Taiwan
- Faculty of Medicine, National Yang-Ming University, No. 155, Section 2, Linong St, Beitou District, Taipei City, Taiwan
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Belyak EA, Paskhin DL, Lazko FL, Prizov AP, Asratyan SA. [Endoscopic sciatic nerve decompression]. Khirurgiia (Mosk) 2021:66-75. [PMID: 34786918 DOI: 10.17116/hirurgia202111166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To improve treatment outcomes in patients with sciatic nerve neuropathy. MATERIAL AND METHODS The first results of endoscopic sciatic nerve decompression in 6 patients with sciatic neuropathy (mean age 47±6.7 years) are presented. The authors developed and described new and unique technique for this procedure. All patients suffered severe neuropathic pain syndrome with neurologic disorders. All patients underwent endoscopic sciatic nerve decompression in prone position. RESULTS Mean VAS score of preoperative pain syndrome was 7.8±0.37. In 3 months after surgery, this value decreased up to 1.5 scores. Complete regression of pain syndrome and significant reduction of neurologic symptoms were noted in 5 out of 6 patients (83%). CONCLUSION Primary data characterize the developed method as an easy, minimally invasive and effective procedure for pain relief and fast recovery of lower extremity function in these patients.
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Affiliation(s)
- E A Belyak
- Peoples' Friendship University of Russia, Moscow, Russia.,Buyanov Clinical Hospital, Moscow, Russia
| | | | - F L Lazko
- Peoples' Friendship University of Russia, Moscow, Russia.,Buyanov Clinical Hospital, Moscow, Russia
| | - A P Prizov
- Peoples' Friendship University of Russia, Moscow, Russia.,Buyanov Clinical Hospital, Moscow, Russia
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Aguilera-Bohórquez B, Pacheco J, Castillo L, Calvache D, Cantor E. Complications of Hip Endoscopy in the Treatment of Subgluteal Space Pathologies. Arthroscopy 2021; 37:2152-2161. [PMID: 33621650 DOI: 10.1016/j.arthro.2021.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess complications of hip endoscopy in patients with subgluteal space pathologies. METHODS This was a retrospective study of patients diagnosed with sciatic nerve entrapment (SNE), ischiofemoral impingement (IFI), and rupture of the proximal origin of the hamstring muscles (RHM) who underwent a hip endoscopy from January 2012 to December 2018, after a minimum of 3 months of conservative management without satisfactory results. Complications were documented and graded using the adapted system of Clavien-Dindo. Revision surgeries were classified as treatment failures. Function was evaluated by the Western Ontario McMaster Universities Osteoarthritis Index before and 12 months after the surgical procedure. RESULTS A total of 97 hips with subgluteal space pathologies were treated with hip endoscopy. This total consisted of 77 hips with SNE, 5 with IFI, 12 with SNE + IFI, and 3 hips with RHM. Minor (Clavien-Dindo I-II) and major (Clavien-Dindo III-V) complications occurred in 7.22% (7) (95% confidence interval 3.54%-14.15%) and 12.37% (12) (95% confidence interval 7.22%-20.39%). Grade II, III, and IV complications were reported in 7.22% (7), 7.22%, and 5.15% (5) hips, respectively. Temporary nerve injury of the sciatic nerve, hematoma, and permanent nerve injury of the posterior femoral cutaneous nerve were the most common grade II, grade III, and grade IV complications, respectively. The revision rate was 6.19% (6) and entrapment of the sciatic nerve was the main cause of reoperation. No statistically significant differences were found between cases with and without complications in the Western Ontario McMaster Universities Osteoarthritis Index scores evaluated before and after surgery (P > .05). CONCLUSIONS A high rate of complications associated with hip endoscopy were observed in patients with SNE, IFI, and RHM. Sciatic nerve and posterior femoral cutaneous nerve injury were the most frequent events. LEVEL OF EVIDENCE IV, case series type.
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Affiliation(s)
| | - Julio Pacheco
- Hip Preservation Unit, Institute of Osteoarticular Diseases, Centro Médico Imbanaco, Cali, Colombia; Pontificia Universidad Javeriana, Cali, Colombia
| | - Lizardo Castillo
- Hip Preservation Unit, Institute of Osteoarticular Diseases, Centro Médico Imbanaco, Cali, Colombia; Pontificia Universidad Javeriana, Cali, Colombia
| | - Daniela Calvache
- Hip Preservation Unit, Institute of Osteoarticular Diseases, Centro Médico Imbanaco, Cali, Colombia
| | - Erika Cantor
- Institute of Statistics, Universidad de Valparaiso, Valparaiso, Chile
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Vij N, Kiernan H, Bisht R, Singleton I, Cornett EM, Kaye AD, Imani F, Varrassi G, Pourbahri M, Viswanath O, Urits I. Surgical and Non-surgical Treatment Options for Piriformis Syndrome: A Literature Review. Anesth Pain Med 2021; 11:e112825. [PMID: 34221947 PMCID: PMC8241586 DOI: 10.5812/aapm.112825] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/30/2021] [Indexed: 01/03/2023] Open
Abstract
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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Affiliation(s)
- Neeraj Vij
- University of Arizona College of Medicine-Phoenix, Phoenix, USA
| | - Hayley Kiernan
- University of Arizona College of Medicine-Phoenix, Phoenix, USA
| | - Roy Bisht
- University of Arizona College of Medicine-Phoenix, Phoenix, USA
| | - Ian Singleton
- University of Arizona College of Medicine-Phoenix, Phoenix, USA
| | - Elyse M. Cornett
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, USA
| | - Alan David Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, USA
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Pourbahri
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Omar Viswanath
- University of Arizona College of Medicine-Phoenix, Phoenix, USA
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, USA
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, USA
- Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, USA
| | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, USA
- Southcoast Health Physicians Group Pain Medicine, Wareham, USA
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Dekopov AV, Tomsky AA, Isagulyan ED, Ogurtsova AA, Kozlova AB. [Treatment of sciatic posttraumatic neuropathy with chronic neuromodulation and endoscopic technics]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 84:64-71. [PMID: 33095534 DOI: 10.17116/neiro20208405164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Sciatic nerve injury in the deep gluteal space is a major clinical problem due to microsurgical manipulations in this region are limited in scope. We offer new endoscopic approach to the sciatic nerve in the deep gluteal space which allows to perform microsurgical manipulations, neurophysiological mapping and electrode installation for the chronic nerve stimulation. MATERIAL AND METHOD 3 patients with sciatic neuropathy have been operated. Before the operation they suffered from neuropathic pain in the the posterior thigh and calf, reaching 7-8 points on the visual analog scale (VAS). Paresis of triceps surae and biceps femur also was occurred. We performed endoscopic approach to the deep gluteal space through a small incision under the gluteal fold. Microsurgical external and internal decompression of sciatic nerve was performed under the endoscopic control. Next, intra-trunk nerve mapping was performed to visualize sensory fibers. Cylindrical electrodes for chronic neurostimulation were directly placed on the sensory fibers of sciatic nerve. RESULTS Pain relief was obtained in all cases after activating the simulator, the patient noted a 50% reduction in pain. Muscle straight restoration was observed in all cases 2-3 months later. The clinical effect was stable in the follow up (6 months). CONCLUSION This technique, combining minimal invasiveness and intraoperative neurophysiological control, makes it possible to optimally position the electrode, both to achieve positive analgesic effect and for potential restoration of nerve function.
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Affiliation(s)
- A V Dekopov
- Burdenko Neurosurgicai Center, Moscow, Russia
| | - A A Tomsky
- Burdenko Neurosurgicai Center, Moscow, Russia
| | | | | | - A B Kozlova
- Burdenko Neurosurgicai Center, Moscow, Russia
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Deep gluteal syndrome is defined as a non-discogenic sciatic nerve disorder with entrapment in the deep gluteal space: a systematic review. Knee Surg Sports Traumatol Arthrosc 2020; 28:3354-3364. [PMID: 32246173 DOI: 10.1007/s00167-020-05966-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/23/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Clinicians are not confident in diagnosing deep gluteal syndrome (DGS) because of the ambiguity of the DGS disease definition and DGS diagnostic pathway. The purpose of this systematic review was to identify the DGS disease definition, and also to define a general DGS diagnostic pathway. METHODS A systematic search was performed using four electronic databases: PubMed, MEDLINE, EMBASE, and Google Scholar. In eligibility criteria, studies in which cases were explicitly diagnosed with DGS were included, whereas review articles and commentary papers were excluded. Data are presented descriptively. RESULTS The initial literature search yielded 359 articles, of which 14 studies met the eligibility criteria, pooling 853 patients with clinically diagnosed with DGS. In this review, it was discovered that the DGS disease definition was composed of three parts: (1) non-discogenic, (2) sciatic nerve disorder, and (3) nerve entrapment in the deep gluteal space. In the diagnosis of DGS, we found five diagnostic procedures: (1) history taking, (2) physical examination, (3) imaging tests, (4) response-to-injection, and (5) nerve-specific tests (electromyography). History taking (e.g. posterior hip pain, radicular pain, and difficulty sitting for 30 min), physical examination (e.g. tenderness in deep gluteal space, pertinent positive results with seated piriformis test, and positive Pace sign), and imaging tests (e.g. pelvic radiographs, spine and pelvic magnetic resonance imaging (MRI)) were generally performed in cases clinically diagnosed with DGS. CONCLUSION Existing literature suggests the DGS disease definition as being a non-discogenic sciatic nerve disorder with entrapment in the deep gluteal space. Also, the general diagnostic pathway for DGS was composed of history taking (posterior hip pain, radicular pain, and difficulty sitting for 30 min), physical examination (tenderness in deep gluteal space, positive seated piriformis test, and positive Pace sign), and imaging tests (pelvic radiographs, pelvic MRI, and spine MRI). This review helps clinicians diagnose DGS with more confidence. LEVEL OF EVIDENCE IV.
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Park JW, Lee YK, Lee YJ, Shin S, Kang Y, Koo KH. Deep gluteal syndrome as a cause of posterior hip pain and sciatica-like pain. Bone Joint J 2020; 102-B:556-567. [PMID: 32349600 DOI: 10.1302/0301-620x.102b5.bjj-2019-1212.r1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Deep gluteal syndrome is an increasingly recognized disease entity, caused by compression of the sciatic or pudendal nerve due to non-discogenic pelvic lesions. It includes the piriformis syndrome, the gemelli-obturator internus syndrome, the ischiofemoral impingement syndrome, and the proximal hamstring syndrome. The concept of the deep gluteal syndrome extends our understanding of posterior hip pain due to nerve entrapment beyond the traditional model of the piriformis syndrome. Nevertheless, there has been terminological confusion and the deep gluteal syndrome has often been undiagnosed or mistaken for other conditions. Careful history-taking, a physical examination including provocation tests, an electrodiagnostic study, and imaging are necessary for an accurate diagnosis. After excluding spinal lesions, MRI scans of the pelvis are helpful in diagnosing deep gluteal syndrome and identifying pathological conditions entrapping the nerves. It can be conservatively treated with multidisciplinary treatment including rest, the avoidance of provoking activities, medication, injections, and physiotherapy. Endoscopic or open surgical decompression is recommended in patients with persistent or recurrent symptoms after conservative treatment or in those who may have masses compressing the sciatic nerve. Many physicians remain unfamiliar with this syndrome and there is a lack of relevant literature. This comprehensive review aims to provide the latest information about the epidemiology, aetiology, pathology, clinical features, diagnosis, and treatment. Cite this article: Bone Joint J 2020;102-B(5):556-567.
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Affiliation(s)
- Jung Wee Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yun Jong Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea Seongnam, South Korea
| | - Seunghwan Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Department of Orthopedic Surgery, Seoul National University College of Medicine Seongnam, South Korea
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Bloom DA, Essilfie AA, Wolfert A, Youm T. Infected Hematoma After Endoscopic Sciatic Nerve Decompression. Arthrosc Sports Med Rehabil 2020; 2:e171-e174. [PMID: 32368754 PMCID: PMC7190546 DOI: 10.1016/j.asmr.2019.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/16/2019] [Indexed: 12/30/2022] Open
Abstract
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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Affiliation(s)
- David A Bloom
- New York University Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Anthony A Essilfie
- New York University Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Adam Wolfert
- New York University Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Thomas Youm
- New York University Langone Orthopedic Hospital, New York, New York, U.S.A
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