Decompression of the sciatic nerve entrapment caused by post-inflammatory scarring

Anatomical Proximity Between Sciatic Nerve and Ischial Spine and its Relationship to the Development of Deep Gluteal Pain Syndrome

OBJECTIVE

Deep gluteal syndrome (DGS) is a medical diagnosis in which the pathoanatomy of the subgluteal space contributes to pain. The growing recognition that gluteal neuropathies can be associated with the presence of a bone-neural conflict with irritation or compression may allow us to shed some light on this pathology. This study aims to determine whether the location of the sciatic nerve (SN) in relation to the ischial spine (IS) contributes to the development of DGS.

METHODS

The SN - IS relationship was analyzed based on magnetic resonance imaging (MRI) in 15 surgical patients (SPs), who underwent piriformis release, and in 30 control patients who underwent MRI of the pelvis for reasons unrelated to sciatica. The SN exit from the greater sciatic foramen was classified as either zone A (medial to the IS); zone B (on the IS); or zone C (lateral to the IS).

RESULTS

The SN was significantly closer to the IS in SPs than in MRI controls (P = 0.014). When analyzing patients of similar age, SNs in SPs were significantly closer (P = 0.0061) to the IS, and located in zone B significantly more (P = 0.0216) as compared to MRI controls. Patients who underwent surgery for piriformis release showed a significant decrease in pain postoperatively (P < 0.0001).

CONCLUSIONS

The results from this study suggest that the relationship between the IS and SN may play a role in the development of DGS. This may also help establish which patients would benefit more from surgical intervention.

Bilateral Sciatic Nerve Compression Due to Abnormal Termination of the Small Saphenous Vein Into the Popliteal Vein: A Rare Mechanism of Pseudoclaudication of the Lower Extremities

Claudication in the young population is a rare condition derived from varied neurogenic and vascular conditions. We report a case of bilateral claudication of the lower extremities in a young athlete after intense training. Apart from tenderness to deep palpation of the popliteal fossa, physical and laboratory examinations did not reveal any abnormal findings. According to the patient's symptoms, sciatic nerve entrapment to the popliteal fossa was suspected and bilateral surgical exploration of the sciatic nerve was performed. The sciatic nerve was found to be entrapped before its division to the tibial and common peroneal nerves from the terminal branch of the small saphenous vein (SSV) into the popliteal vein (PV). The terminal section of SSV was subsequently ligated and resected to relieve the pressure on the sciatic nerve. One year after surgery, the patient was able to run long distances as well as sprint and train without any restriction. Rare conditions may lead to pseudoclaudication in young individuals and athletes during exercise. Normal physical and laboratory tests must raise the suspicion of sciatic nerve compression from fibrous bands or abnormal anastomotic veins that may also exist bilaterally. Surgical exploration along with sciatic nerve release remains the only treatment solution when conservative treatment fails to alleviate the symptoms.