The Transgluteal Approach for Decompression of Sciatic Nerve Entrapment (Piriformis Syndrome) with Intraoperative Neurophysiology: A Technical Note

Abstract

Although the transgluteal approach splitting the gluteus maximus muscle has been reported as a posterior approach for sciatic nerve entrapment (piriformis syndrome), detailed descriptions of the surgical steps and intraoperative findings have not been published. Thus, the objective of this study was to present the transgluteal approach for decompression surgery of sciatic nerve entrapment in the subgluteal space. A method of circumferentially decompressing the sciatic nerve from the surrounding piriformis muscle was devised by decompressing it to the level of the sacrotuberous ligament, which was more proximal than the existing decompression range. Surgical findings are presented step-by-step in the stages of localization, exposure, and decompression of the sciatic nerve during surgery. We also emphasize the importance of intraoperative nerve monitoring to identify the sciatic nerve and its branches and the inferior gluteal nerve during surgery performed under general anesthesia. Our observations of intraoperative electromyographic responses by individual nerve stimulation are summarized and reported.