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Sciatic Nerve Release/Piriformis Tenotomy: Endoscopic Surgery

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Hip Preservation Surgery

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Abstract

Deep gluteal syndrome (DGS) is an underdiagnosed entity characterized by pain and/or dysesthesias in the buttock area, hip or posterior thigh and/or radicular pain due to a non-discogenic and extrapelvic sciatic nerve entrapment in the subgluteal space. The development of periarticular hip endoscopy has led to an understanding of the pathophysiological mechanisms underlying piriformis syndrome, which has supported its further classification. The whole sciatic nerve trajectory in the deep gluteal space can be addressed by an endoscopic surgical technique, allowing the treatment of the diverse causes of sciatic nerve entrapment. Endoscopic decompression of the sciatic nerve appears useful in improving function and diminishing hip pain in sciatic nerve entrapments within the subgluteal space.

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Author information

Authors and Affiliations

  1. Orthopedic Surgery Department, Clinica Mompia, Santander, Cantabria, Spain

    Luis Perez-Carro & Natalia Fernandez Escajadillo

  2. Department of Radiology, Diagnóstico Médico Cantabria (DMC), Santander, Cantabria, Spain

    Moises Fernandez Hernando & Luis Cerezal Pesquera

  3. Faculty of Medicine, Department of Anatomy and Human Embryology, University of Barcelona, Barcelona, Spain

    Ivan Saenz Navarro

  4. Clinical Hospital Center, Zemun, Belgrade, Serbia

    Aleksandar Vojvodick

Authors
  1. Luis Perez-Carro
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  2. Moises Fernandez Hernando
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  3. Luis Cerezal Pesquera
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  4. Ivan Saenz Navarro
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  5. Natalia Fernandez Escajadillo
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  6. Aleksandar Vojvodick
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Editor information

Editors and Affiliations

  1. Hip and Sports Medicine Unit, Lyon Ortho Clinic, Clinique de la Sauvegarde, Lyon, France

    Nicolas Bonin

  2. Hip Department (CAD), Gaetano Pini - CTO Orthopedic Institute, University of Milan, Milan, Italy

    Filippo Randelli

  3. Young Adult Hip Service, Addenbrooke’s - Cambridge University Hospital, Cambridge, UK

    Vikas Khanduja

1 Electronic Supplementary Material

Left hip. Endoscopy shows the sciatic nerve compression by a proximal fibrovascular band. Note the bleeding vessel during resection of the band (MP4 37373 kb)

Left hip: type 2 band release (MP4 21337 kb)

Left hip: type 2 band release (MP4 37591 kb)

Left hip: Endoscopic view of type-3 scarred bands in a 51-year-old female with DGS (MP4 15711 kb)

Right hip: The whole sciatic nerve trajectory in the deep gluteal space can be addressed by an endoscopic surgical technique, allowing the treatment of the diverse causes of sciatic nerve entrapment (MP4 56062 kb)

Left hip. Approach to peritrochanteric space. Scope and camera in the midanterior portal (MP4 67364 kb)

Right hip: Examination and inspection of the peritrochanteric space (MP4 31125 kb)

Fibrous bands from the trochanteric bursa may need to be removed in order to best visualize the medius attachment to the greater trochanter. A blunt probe or surgical dissector can then be employed to expose the sciatic nerve and determine the tension (MP4 40517 kb)

Right hip: Endoscopic view of the sciatic nerve and posterior femoral cutaneous nerve (MP4 19026 kb)

Left hip: Releasing bands anchored to the sciatic nerve with undefined distribution (type 3) (MP4 72498 kb)

Left hip: Carefully grasp the tendon with arthroscopic scissors and pull the scissors toward you to ensure only the tendon is released (MP4 23324 kb)

Right hip: Endoscopy view showing the use of radiofrequency probe to release the tendon (MP4 78735 kb)

Left hip: Endoscopic view showing a type B of Beaton. After dissection a divided sciatic nerve passing through and below the piriformis muscle is identified (MP4 11487 kb)

Left Hip. Endoscopic view of obturator splitting the sciatic nerve and its release (MP4 23955 kb)

Right hip: The kinematic excursion of the sciatic nerve is assessed after release, with the leg in flexion with internal/external rotation and full extension with internal/external rotation (MP4 70325 kb)

Right hip. Intraneural Plasma Rich Growth Factors to enhance healing (MP4 12520 kb)

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Perez-Carro, L., Hernando, M.F., Cerezal Pesquera, L., Navarro, I.S., Escajadillo, N.F., Vojvodick, A. (2020). Sciatic Nerve Release/Piriformis Tenotomy: Endoscopic Surgery. In: Bonin, N., Randelli, F., Khanduja, V. (eds) Hip Preservation Surgery . Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-61186-9_28

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  • DOI: https://doi.org/10.1007/978-3-662-61186-9_28

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-61185-2

  • Online ISBN: 978-3-662-61186-9

  • eBook Packages: MedicineMedicine (R0)

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