New Endoscopic technique allows release of the sciatic nerve without performing piriformis tenotomy in Deep gluteal pain syndrome

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.

Dante Parodi et al conducted a study to determine the medium-term functional results of endoscopic release of the sciatic nerve without resection of the piriformis tendon. Investigation performed at Cl´ınica RedSalud Providencia, Santiago, Chile.

‘The lateral compartment and the characteristics of the superficial and deep trochanteric bursa were assessed, as well as the septa and/or any extension of a hypertrophic nature, and a wide bursectomy was performed. Then the insertion of the gluteus maximus tendon was identified, which was considered to be the landmark to access the deep gluteal space. Once the sciatic nerve had been identified, its adjoining fibrovascular adhesions were released with blunt and controlled radiofrequency dissection maneuvers, performing this procedure from distal to proximal and then to the sciatic notch.’

A prospective, observational study included 57 patients who underwent an endoscopic operation for sciatic nerve entrapment. 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.

Key findings of the study were:

• 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.

The authors concluded that – “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.

Further reading:

Deep Gluteal Pain Syndrome Endoscopic Technique and Medium-Term Functional Outcomes

Dante Parodi, Diego Villegas et al

J Bone Joint Surg Am. 2023;105:762-70

http://dx.doi.org/10.2106/JBJS.22.00394.