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.
Highlights
BackgroundDeep gluteal syndrome (DGS) describes non-discogenic and extra-pelvic entrapment of sciatic nerve in the deep gluteal space, called subgluteal space between the middle and deep gluteal aponeurotic layers [1,2]
Another 51 articles were excluded based on the pre-defined selection criteria resulting in five studies for potential inclusion
One more study needed exclusion that had the duplicate data from its previous study, making only four studies eligible for this systematic review
Summary
Deep gluteal syndrome (DGS) describes non-discogenic and extra-pelvic entrapment of sciatic nerve in the deep gluteal space, called subgluteal space between the middle and deep gluteal aponeurotic layers [1,2]. The anatomic boundaries of deep gluteal space include gluteus maximus posteriorly, femoral neck with greater and lesser trochanters anteriorly, sacrotuberous ligament medially, and linea aspera laterally (Figure 1). How to cite this article Metikala S, Sharma V (March 14, 2022) Endoscopic Sciatic Neurolysis for Deep Gluteal Syndrome: A Systematic Review. STL: Sacrotuberous ligament, PF: Piriformis, SN: Sciatic nerve, H: Hamstring tendon, LA: Linea aspera, GT: Greater trochanter
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