1
|
Poutoglidou F, Piagkou M, Totlis T, Tzika M, Natsis K. Sciatic Nerve Variants and the Piriformis Muscle: A Systematic Review and Meta-Analysis. Cureus 2020; 12:e11531. [PMID: 33354475 PMCID: PMC7746330 DOI: 10.7759/cureus.11531] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 11/24/2022] Open
Abstract
The present systematic review and meta-analysis provides a comprehensive assessment of the sciatic nerve (SN) variants relative to the piriformis muscle (PM) and compares those variants' prevalence among different geographical populations with respect to gender and laterality. A database search was conducted to identify cadaveric studies pertinent to SN variants relative to the PM. A total of 44 articles were included. The typical morphological pattern (type A, with the SN passing undivided below the PM) was found to be the most common variant, with 90% pooled prevalence. SN variants were more common among East Asians, with a 31% pooled prevalence of total variants. No significant differences were established with respect to gender and laterality. In greater than 10% of the population, the SN coursed through or above piriformis. Patients' epidemiological characteristics may predispose them to certain variants. The common peroneal nerve (CPN) is more susceptible to injury during a total hip arthroplasty or a hip arthroscopy where anomalies are encountered. As anatomical variants are commonly associated with piriformis syndrome, they should always be considered during diagnosis and treatment.
Collapse
Affiliation(s)
| | - Maria Piagkou
- Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | - Trifon Totlis
- Orthopaedic Surgery, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Maria Tzika
- Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Konstantinos Natsis
- Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
| |
Collapse
|
2
|
Barbosa ABM, Santos PVD, Targino VA, Silva NDA, Silva YCDM, Gomes FB, Assis TDO. Sciatic nerve and its variations: is it possible to associate them with piriformis syndrome? ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:646-653. [DOI: 10.1590/0004-282x20190093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/05/2019] [Indexed: 11/21/2022]
Abstract
ABSTRACT The sciatic nerve forms from the roots of the lumbosacral plexus and emerges from the pelvis passing inferiorly to the piriformis muscle, towards the lower limb where it divides into common tibial and fibular nerves. Anatomical variations related to the area where the nerve divides, as well as its path, seem to be factors related to piriformis syndrome. Objective: To analyze the anatomical variations of the sciatic nerve and its clinical implications. Methods: This was a systematic review of articles indexed in the PubMed, LILACS, SciELO, SpringerLink, ScienceDirect and Latindex databases from August to September 2018. Original articles covering variations of the sciatic nerve were included. The level of the sciatic nerve division and its path in relation to the piriformis muscle was considered for this study. The collection was performed by two independent reviewers. Results: At the end of the search, 12 articles were selected, characterized according to the sample, method of evaluation of the anatomical structure and the main results. The most prevalent anatomical variation was that the common fibular nerve passed through the piriformis muscle fibers (33.3%). Three studies (25%) also observed anatomical variations not classified in the literature and, in three (25%) the presence of a double piriformis muscle was found. Conclusion: The results of this review showed the most prevalent variations of the sciatic nerve and point to a possible association of this condition with piriformis syndrome. Therefore, these variations should be considered during the semiology of disorders involving parts of the lower limbs.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Thiago de Oliveira Assis
- Centro Universitário UNIFACISA, Brasil; Universidade Federal da Paraíba, Brasil; Universidade Estadual da Paraíba, Brasil
| |
Collapse
|
3
|
Aktan İkiz ZA, Bilge O, Üçerler H, Çelik S, Boduç E. Siyatik sinirin varyasyon anatomisi ve klinik yansımaları. EGE TIP DERGISI 2018. [DOI: 10.19161/etd.414980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
4
|
Tomaszewski KA, Graves MJ, Henry BM, Popieluszko P, Roy J, Pękala PA, Hsieh WC, Vikse J, Walocha JA. Surgical anatomy of the sciatic nerve: A meta-analysis. J Orthop Res 2016; 34:1820-1827. [PMID: 26856540 DOI: 10.1002/jor.23186] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 02/03/2016] [Indexed: 02/04/2023]
Abstract
The sciatic nerve has varying anatomy with respect to the piriformis muscle. Understanding this variant anatomy is vital to avoiding iatrogenic nerve injuries. A comprehensive electronic database search was performed to identify articles reporting the prevalence of anatomical variations or morphometric data of the sciatic nerve. The data found was extracted and pooled into a meta-analysis. A total of 45 studies (n = 7068 lower limbs) were included in the meta-analysis on the sciatic nerve variations with respect to the piriformis muscle. The normal Type A variation, where the sciatic nerve exits the pelvis as a single entity below the piriformis muscle, was most common with a pooled prevalence of 85.2% (95%CI: 78.4-87.0). This was followed by Type B with a pooled prevalence of 9.8% (95%CI: 6.5-13.2), where the sciatic nerve bifurcated in the pelvis with the exiting common peroneal nerve piercing, and the tibial nerve coursing below the piriformis muscle. In morphometric analysis, we found that the pooled mean width of the sciatic nerve at the lower margin of the piriformis muscle was 15.55 mm. The pooled mean distance of sciatic nerve bifurcation from the popliteal fossa was 65.43 mm. The sciatic nerve deviates from its normal course of pelvic exit in almost 15% of cases. As such we recommend that a thorough assessment of sciatic nerve variants needs to be considered when performing procedures in the pelvic and gluteal regions in order to reduce the risk of iatrogenic injury. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1820-1827, 2016.
Collapse
Affiliation(s)
- Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, Krakow, Poland. .,Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland.
| | - Matthew J Graves
- International Evidence-Based Anatomy Working Group, Krakow, Poland.,Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland
| | - Brandon Michael Henry
- International Evidence-Based Anatomy Working Group, Krakow, Poland.,Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland
| | - Patrick Popieluszko
- International Evidence-Based Anatomy Working Group, Krakow, Poland.,Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland
| | - Joyeeta Roy
- International Evidence-Based Anatomy Working Group, Krakow, Poland.,Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland
| | - Przemysław A Pękala
- International Evidence-Based Anatomy Working Group, Krakow, Poland.,Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland
| | - Wan Chin Hsieh
- International Evidence-Based Anatomy Working Group, Krakow, Poland.,First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jens Vikse
- International Evidence-Based Anatomy Working Group, Krakow, Poland.,Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland
| | - Jerzy A Walocha
- International Evidence-Based Anatomy Working Group, Krakow, Poland.,Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland
| |
Collapse
|