Hip Pelvis.  2018 Mar;30(1):29-36. 10.5371/hp.2018.30.1.29.

Effectiveness of Endoscopic Sciatic Nerve Decompression for the Treatment of Deep Gluteal Syndrome

• Ham DH
• Chung WC
• Jung DU

• KMID: 2408183
• DOI: http://doi.org/10.5371/hp.2018.30.1.29

Abstract

PURPOSE
The purpose of this retrospective study was to evaluate clinical outcomes of endoscopic nerve decompression in patients with deep gluteal syndromes (DGS).
MATERIALS AND METHODS
Between October 2013 and March 2015, 24 patients who underwent surgical treatment of DGS were retrospectively included in this study. The mean age was 47 years (range, 35 to 76 years), and there were 11 males and 13 females. The mean duration of pain was 12 months (range, 5 to 35 months) and the mean follow-up period was 32 months (range, 26 to 45 months). Clinical evaluations included the visual analog scale (VAS) pain score, modified Harris hip score (mHHS), and the symptom-rating scale.
RESULTS
Significant improvement in symptoms following endoscopic decompression were achieved as measured using the VAS score (decrease in the mean from 7.1±0.9 to 2.5±1.5; P < 0.001) and mHHS (increase from 59.4±6.5 to 85.0±8.3; P < 0.001).
CONCLUSION
Endoscopic sciatic nerve decompression was satisfactory for treating recalcitrant DGS, making it an effective treatment option to improve symptoms of DGS.

Keyword

Deep gluteal syndrome; Endoscopic decompression; Sciatic nerve

MeSH Terms

Decompression*
Female
Follow-Up Studies
Hip
Humans
Male
Retrospective Studies
Sciatic Nerve*
Visual Analog Scale

Figure

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  Fig. 1 Flow-chart showing treatment process. A flow-chart showing the decision making process for endoscopic sciatic nerve decompression of seating posterior hip pain.Adapted from the article of Park MS et al. (BMC Musculoskelet Disord 2016;17:218)4).

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  Fig. 2 Endoscopic portals placement including additional auxiliary portal. (A) Anterolateral portal, (B) posterolateral portal, (C) auxiliary posterolateral portal. Allowed for better visualization of the sciatic nerve up to the sciatic notch.

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  Fig. 3 (A) Entrapment of sciatic nerve (SN) by fibrovascular band (FVB) and piriformis muscle (PM) were observed. (B) SN after decompression by releasing FVB and PM were observed. (C, D) Adequate excursion by probing after decompression were observed.

• 

  Fig. 4 (A–C) Sciatic nerve (SN) is compressed by fibrous tissue (FT), inferior gluteal vessels (IGV) and priformis muscle (PM). (D) After decompression of SN (also used Guardix-SG for avoiding recurrence which is an adhesion barrier bioresorbable membrane).

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