Sciatic Nerve Release Research Articles

Liberación endoscópica del nervio ciático en el síndrome del espacio subglúteo: técnica quirúrgica y serie de casos clínicos.

Objectives: To describe the surgical technique for an endoscopic sciatic nerve release in deep gluteal syndrome and to evaluate its results. Study design and Methods. Retrospective observational study of a consecutive case series that underwent endoscopic surgery by the Arthroscopy Unit from our hospital. All of them were diagnosed clinically and radiologically (using magnetic resonance imaging) of sciatic nerve entrapment. Results. Eight patients underwent surgery with a mean age of 44 years old and a majority of women. The mean duration of surgery was 55 minutes with a mean hospital stay of one day. Anatomical muscular alterations were found in six cases and fibrovascular bands in two. Pain, assessed by Visual Analogue Scale (VAS), decreased from 8'00 to 2'25. The patients were on average quite satisfied. One complication was described and just one case required salvage surgery. Conclusions. Sciatic nerve release is an effective technique in patients with subgluteal space syndrome due to sciatic entrapment, since it improves the patient's symptoms. The use of endoscopy provides added value, as it allows visualization of the nerve using minimally invasive techniques.

Does endoscopic piriformis tenotomy provide safe and complete tendon release? A cadaver study

BackgroundEndoscopic piriformis release (EPR) is among the available treatments for piriformis syndrome. This procedure typically involves dividing the muscle near the sciatic nerve in the sub-gluteal space, which contains numerous blood vessels and nerves. The objectives of this prospective cadaver study were: 1) to assess the reproducibility and quality of endoscopic piriformis tenotomy near the greater trochanter; 2) to detect iatrogenic injuries to the lateral hip rotators, nerves, and vessels; 3) and to define the surgical safety margins relative to the sciatic nerve and inferior gluteal bundle. HypothesisEPR at the greater trochanter ensures full release of the muscle with a limited risk of neuro-vascular injury. Material and methodsEPR was performed via two portals on 10 cadaver hips preserved in zinc chloride and placed in the prone position. A third, ancillary portal was required in 7 cases. The area was then dissected with the Kocher-Langenbeck approach to allow an assessment of the tenotomy, detect iatrogenic injuries, and measure the distances separating the tenotomy site from the sciatic nerve and inferior gluteal artery. ResultsComplete tenotomy was achieved in 9 (90%) cases. The tendon adhered to the capsule in 2 (20%) cases and showed acquired avulsion in 1 case. No injuries to the sciatic nerve or inferior gluteal artery occurred. Mean distances from the tenotomy site were 5.21±0.59cm (range, 4.5–6.6cm) for the sciatic nerve and 7.1±0.89cm (range, 5.4–8.5cm) for the inferior gluteal artery. DiscussionEPR by a tenotomy at the greater trochanter without sciatic nerve release provides full release of the muscle with satisfactory safety margins and a short learning curve. Level of evidenceIII, prospective cadaver case-control study.

Endoscopic Sciatic Nerve Decompression After Fracture or Reconstructive Surgery of the Acetabulum in Comparison With Endoscopic Treatments in Idiopathic Deep Gluteal Syndrome.

The purpose of this study was to assess the endoscopic findings of the sciatic nerve and clinical outcomes of major traumatic sciatic nerve neuropathies after fracture or reconstructive surgery of the acetabulum with idiopathic deep gluteal syndrome (DGS) groups. Retrospective review of patient reports. Level I trauma center of a tertiary university hospital. The study included 70 patients who consecutively underwent endoscopic sciatic nerve decompression. Patients who had previous fractures or reconstructive surgeries of the acetabulum were categorized as the major trauma group, whereas those without major trauma were categorized as the idiopathic group (45 patients) after a minimum of 24-months of follow-up period. The results were evaluated using the modified Harris Hip Score (mHHS), Hip outcome, and 12-Item Short Form Health Survey scores, respectively. In the major trauma group, all patients with sensory symptoms showed some degree of relief after the endoscopic sciatic nerve release. None of the patients with complete foot drop demonstrated complete improvement. Three patients with motor weakness without foot drop showed complete improvement in motor function. The mean mHHS increased from 61.5 ± 13.4 to 84.1 ± 8.1 (P = 0.031). In the idiopathic DGS group, the mean mHHS increased from 73.8 ± 10.3 to 94.4 ± 5.3 (P = 0.003). The Benson outcomes rating in the major trauma group was statistically lower than that in the idiopathic DGS group. Endoscopic release of the sciatic nerve after fractures or reconstructive surgeries could provide some improvements without complications. However, more favorable outcomes were observed in the idiopathic DGS group.

Bone graft of a femoral head by fragments of neurogenic heterotopic ossification

Neurogenic heterotopic ossification (NHO) are a common complication after lesions of the central nervous system (10–23% after head injury). The late removal of hip NHOs sometimes causes the risk of femoral head and femoral neck fracture per or postoperatively. Indeed ankylosis of a joint eventually induces bone loss and joint destruction. A 23-year-old patient who suffered a severe TBI in 2012 in a military context presents multiple NHOs, which especially affects both hips. On the right side, CT of the pelvis shows a circumferential NHO that ankyloses the joint. The NHO therefore absorbs the stresses on the femoral head which is thus off-loaded. This causes bone loss quantified by CT. A surgical indication for excision is established for functional reasons and because of the risks of the sciatic nerve compression. A soft femoral neck is found during the procedure. A bone graft using the fragments of the NHO is attempted by internal drilling. The procedure ends with a sciatic nerve release. The rehabilitation program started after two weeks of strict bed rest in order to consolidate the bone graft. A passive mobilization program in flexion-extension is started afterward, with a gain of 10° every two weeks. Rotations and abductions-adductions are strictly prohibited during the first 6 weeks. Progressive verticalization is started after 2 months. A radiography of the pelvis shows the integrity of the femoral head 6 weeks after surgery. The patient is then placed in a wheelchair. The NHOs must be removed as soon as they are troublesome. Late surgery is exposing the patient to a joint ankylosis which complicates the surgical procedure and its aftermath. In this case, bone grafting the femoral head with fragments of NHOs seems to be an alternative to explore in order to avoid head-neck resection or the implantation of a hip replacement. However, an extremely cautious rehabilitation seems to be necessary.

Sciatic Nerve Release Following Fracture or Reconstructive Surgery of the Acetabulum

Sciatic neuropathy associated with acetabular fractures can result in disabling long-term symptoms. The purpose of this retrospective study was to evaluate the effect of sciatic nerve release on sciatic neuropathy associated with acetabular fractures and reconstructive acetabular surgery. Between 2000 and 2004, ten patients with sciatic neuropathy associated with an acetabular fracture were treated with release of the sciatic nerve from scar tissue and heterotopic bone. Additional surgical procedures included open reduction and internal fixation of the acetabulum (five patients), removal of hardware and total hip arthroplasty (three patients), and removal of hardware alone (one patient). The average age of the patients was forty-three years. All patients were followed with serial examinations and assessments for a minimum of one year (average, twenty-six months). All patients had partial to complete relief of radicular pain, of diminished sensation, and of paresthesias after the nerve release. Four of seven patients with motor loss and two of five patients with a footdrop demonstrated improvement in function after the nerve release. No patient had evidence of worsening on neurologic examination after the release. Sciatic nerve release during reconstructive acetabular surgery can decrease the sensory symptoms of preoperative sciatic neuropathy associated with a previous acetabular fracture. Motor symptoms, however, are less likely to resolve following nerve release.

Late Hardware-induced Sciatic Nerve Lesions After Acetabular Revision

We encountered late hardware-induced sciatic nerve lesions after acetabular revision in six patients. There were five female patients and one male patient. The mean age of the patients at the time of index acetabular revision was 59.3 years (range, 42-76 years). The interval from the index acetabular revision to the onset of sciatic nerve symptoms averaged 9.4 months (range, 4-16 months) and that from the onset of symptoms to nerve release was 11.3 months (range, 8-13 months), except in two patients with intermittent symptoms in which it was 9 and 10.5 years, respectively. Sciatic nerve release was successful in two patients, but in four patients, the nerve had been partly or entirely cut by the metallic hardware resulting in a permanent deficit. The minimum followup was 2 years (mean, 4 years; range, 2-7 years). Mechanical irritation should be suspected in the case of any late sign of peroneal neuropathy after acetabular revision with a macrocup or antiprotrusion device, and plate fixation of the posterior column. We recommend exploration and nerve release before a permanent lesion of the nerve has developed. Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Sciatic Nerve Release Following Fracture or Reconstructive Surgery of the Acetabulum

Sciatic Nerve Release Following Fracture or Reconstructive Surgery of the Acetabulum

Sciatic Nerve Release Following Fracture or Reconstructive Surgery of the Acetabulum

Sciatic neuropathy associated with acetabular fractures can result in disabling long-term symptoms. The purpose of this retrospective study was to evaluate the effect of sciatic nerve release on sciatic neuropathy associated with acetabular fractures and reconstructive acetabular surgery. Between 2000 and 2004, ten patients with sciatic neuropathy associated with an acetabular fracture were treated with release of the sciatic nerve from scar tissue and heterotopic bone. Additional surgical procedures included open reduction and internal fixation of the acetabulum (five patients), removal of hardware and total hip arthroplasty (three patients), and removal of hardware alone (one patient). The average age of the patients was forty-three years. All patients were followed with serial examinations and assessments for a minimum of one year (average, twenty-six months). All patients had partial to complete relief of radicular pain, of diminished sensation, and of paresthesias after the nerve release. Four of seven patients with motor loss and two of five patients with a footdrop demonstrated improvement in function after the nerve release. No patient had evidence of worsening on neurologic examination after the release. Sciatic nerve release during reconstructive acetabular surgery can decrease the sensory symptoms of preoperative sciatic neuropathy associated with a previous acetabular fracture. Motor symptoms, however, are less likely to resolve following nerve release.

Effects of sciatic-conditioned medium on neonatal rat retinal cells in vitro.

Schwann cells produce and release trophic factors that induce the regeneration and survival of neurons following lesions in the peripheral nerves. In the present study we examined the in vitro ability of developing rat retinal cells to respond to factors released from fragments of sciatic nerve. Treatment of neonatal rat retinal cells with sciatic-conditioned medium (SCM) for 48 h induced an increase of 92.5 +/- 8.8% (N = 7 for each group) in the amount of total protein. SCM increased cell adhesion, neuronal survival and glial cell proliferation as evaluated by morphological criteria. This effect was completely blocked by 2.5 microM chelerythrine chloride, an inhibitor of protein kinase C (PKC). These data indicate that PKC activation is involved in the effect of SCM on retinal cells and demonstrate that fragments of sciatic nerve release trophic factors having a remarkable effect on neonatal rat retinal cells in culture.