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Endoscopic Release of the Piriformis Tendon and Sciatic Nerve Exploration by the Lateral Decubitus Approach Through an Incision on the Iliotibial Band.

ABSTRACT: Entrapment of the sciatic nerve is considered a challenging problem for orthopaedic surgeons. Many surgical interventions (open or endoscopic) have been described as treatments. We describe an endoscopic technique for release of the piriformis tendon and sciatic nerve exploration by the lateral approach through an incision on the iliotibial band.

SUBMITTER: Ilizaliturri VM

PROVIDER: S-EPMC6074723 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Endoscopic Release of the Piriformis Tendon and Sciatic Nerve Exploration by the Lateral Decubitus Approach Through an Incision on the Iliotibial Band.

Ilizaliturri Víctor M VM Arriaga Rubén R Villalobos Félix E FE Suarez-Ahedo Carlos C

Arthroscopy techniques 20180625 7

Entrapment of the sciatic nerve is considered a challenging problem for orthopaedic surgeons. Many surgical interventions (open or endoscopic) have been described as treatments. We describe an endoscopic technique for release of the piriformis tendon and sciatic nerve exploration by the lateral approach through an incision on the iliotibial band. ...[more]

PMID: 30094152

Similar Datasets

Endoscopic release of the piriformis tendon and sciatic nerve exploration.

Project description:Robinson, in 1947 introduced for the first time the term 'piriformis syndrome'. More recently, many etiologies of sciatic nerve entrapment around the gluteal region or the non-discogenic area have been identified, resulting in the use of a new term 'The Deep Gluteal Syndrome'. The purpose of this study was to assess the outcomes following the endoscopic release of sciatic nerve entrapment. Type of study is a consecutive case series. Fifteen patients were diagnosed with sciatic nerve entrapment from January 2012 to December 2015, all of them were treated with endoscopic release of the piriformis tendon and sciatic nerve exploration on lateral decubitus position. Every patient had a minimum follow-up to 2 years. The patient-reported outcome scores used included the modified Harris Hip Score (mHHS), pain was estimated on a visual analog scale (VAS) and the Benson outcomes questionnaire. The patient's mean age was 40.2?years (range, 28-50?years). The score improvement from pre-operative to 24-month follow-up was 46.8-84.9 for mHHS (P?<0.05). The VAS decreased from pre-operative to 24-month follow-up was 7.4-1.86 (P?<?0.05). The Benson outcome ratings were excellent for 11 patients, good for 3 and fair for 1. The Endoscopic Release of the Piriformis Tendon and Sciatic Nerve Exploration showed an improvement of functions, diminishing pain and allowing patients to return to daily activities without symptoms (Level of Evidence: IV).

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Arthroscopic Piriformis Release-A Technique for Sciatic Nerve Decompression.

Project description:Various techniques for piriformis muscle release have been published previously. However, it is imperative we continue to improve on existing techniques as well as develop new ones that may further optimize outcomes. Therefore, we aimed to describe an endoscopic technique for the release of the piriformis muscle in those with symptoms of sciatic nerve compression. Using the posterolateral portal, we are able to perform a complete release of the piriformis from the greater trochanter and the piriformis fossa with care to protect the external rotators and the sciatic nerve. It is our belief that this technique can be easily replicated by practitioners who read this technical note.

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Endoscopic Trochanteric Bursectomy and Iliotibial Band Release for Persistent Trochanteric Bursitis.

Project description:Lateral hip pain associated with trochanteric bursitis is a common orthopedic condition, and can be debilitating in chronic or recalcitrant situations. Conservative management is the most common initial treatment and often results in resolution of symptoms and improved patient outcomes. These modalities include rest, activity modification, physical therapy, anti-inflammatory medication, or corticosteroid injections. However, there is a subset of patients in which symptoms persist despite exhaustive conservative modalities. For these patients, trochanteric bursectomy is a surgical option to address persistent pathology. Previous literature indicates that both open and arthroscopic surgical techniques can be used to address the inflamed bursa and results in good patient outcomes. However, recent advances in hip arthroscopy have allowed for improvements in minimally invasive techniques to address intracapsular and extracapsular pathology of the hip, including recalcitrant trochanteric bursitis. The purpose of this manuscript is to describe our technique for a minimally invasive arthroscopic trochanteric bursectomy.

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Infected Hematoma After Endoscopic Sciatic Nerve Decompression.

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Composite Anatomical Variations between the Sciatic Nerve and the Piriformis Muscle: A Nepalese Cadaveric Study.

Project description:Piriformis syndrome is a rare syndrome which is one of the main causes of nondiscogenic sciatica causing severe low back pain due to entrapment of sciatic nerve either by the hypertrophy or by inflammation of the piriformis muscle. We have carried out dissection in 20 Nepalese cadavers. Out of 40 dissected gluteal regions, 37 exhibited typical appearance of sciatic nerve, piriformis muscle, and their relations resembling type-a, whereas 3 gluteal regions showed composite structural variations resembling type-b and type-c based on Beaton and Anson's classification. Knowledge pertaining to such variations will be helpful during a surgical intervention in the gluteal region and in turn reduces the risk of injuring these nerves which are more susceptible to damage. Our study reports such variations in Nepalese population which will be helpful during evaluation of the pain induction in various test positions and also useful for analysis of the range of the neurological deficiency in sciatic nerve neuropathies. The present study also explains the basis of the unsuccessful attempt of the sciatic nerve block during popliteal block anaesthesia.

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Arthroscopic treatment of iliotibial band syndrome.

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Endoscopic Sciatic Nerve Decompression in the Prone Position-An Ischial-Based Approach.

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Iliotibial Band Lengthening: An Arthroscopic Surgical Technique.

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Endoscopic Sciatic Neurolysis.

Project description:Despite remaining a controversial diagnosis, piriformis syndrome continues to affect patients' quality of life with pain, sitting discomfort, and exercise intolerance. Open sciatic neurolysis has been noted by the senior author to often only bring temporary relief of the symptoms, with the recurrence presumably due to postoperative scar tissue. Minimally invasive techniques used to decompress the nerve have met with mixed results. This article describes a step-by-step surgical technique designed to maximize patient safety, as well as surgeon orientation, and achieve a thorough neurolysis. Preoperative findings suggestive of piriformis syndrome are described and include retro-trochanteric pain, sciatica-like leg pain, and paresthesias, as well as a positive response to computed tomography-guided injection of dilute ropivacaine hydrochloride and 40 mg of triamcinolone. The operation is performed with the patient in the lateral decubitus position through 2 portals 6 to 8 cm apart, allowing for good triangulation. Dissection is undertaken with a combination of radiofrequency and a laparoscopic peanut, with the assistance of a vascular sling to control the sciatic nerve. Encouraging results have been achieved, and with increasing interest in this procedure, a step-by-step technical description with an accompanying video may prove useful for other experienced hip arthroscopists. Pearls and pitfalls are discussed.

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Treatment of peroneal nerve injuries with simultaneous tendon transfer and nerve exploration.

Project description:Common peroneal nerve palsy leading to foot drop is difficult to manage and has historically been treated with extended bracing with expectant waiting for return of nerve function. Peroneal nerve exploration has traditionally been avoided except in cases of known traumatic or iatrogenic injury, with tendon transfers being performed in a delayed fashion after exhausting conservative treatment. We present a new strategy for management of foot drop with nerve exploration and concomitant tendon transfer.We retrospectively reviewed a series of 12 patients with peroneal nerve palsies that were treated with tendon transfer from 2005 to 2011. Of these patients, seven were treated with simultaneous peroneal nerve exploration and repair at the time of tendon transfer.Patients with both nerve repair and tendon transfer had superior functional results with active dorsiflexion in all patients, compared to dorsiflexion in 40% of patients treated with tendon transfers alone. Additionally, 57% of patients treated with nerve repair and tendon transfer were able to achieve enough function to return to running, compared to 20% in patients with tendon transfer alone. No patient had full return of native motor function resulting in excessive dorsiflexion strength.The results of our limited case series for this rare condition indicate that simultaneous nerve repair and tendon transfer showed no detrimental results and may provide improved function over tendon transfer alone.

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