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Endoscopic piriformis tenotomy and sciatic nerve release: Why and how?

Published in N°012 - July / August 2021
Article viewed 133 times

Endoscopic piriformis tenotomy and sciatic nerve release: Why and how?

By Rémy Coulomb (1), Pierre Martz (2) in category SURGICAL TECHNIQUE
(1) CHU de Nîmes, France - (2) CHU de Dijon, France / [email protected]

The term ‘piriformis syndrome’ was first described in 1947 by Robinson, who defined it as entrapment neuropathy involving compression of the sciatic nerve by the piriformis muscle. However, the condition is now recognized to be caused rather by adhesions than by genuine compression of the sciatic nerve.

The term ‘piriformis syndrome’ was first described in 1947 by Robinson, who defined it as entrapment neuropathy involving compression of the sciatic nerve by the piriformis muscle [1,2]. However, the condition is now recognized to be caused rather by adhesions than by genuine compression of the sciatic nerve [3]. ‘Piriformis syndrome’ is therefore restrictive and forms a sub-group of the painful deep gluteal syndrome [4]. Although there has been numerous literature on the topic in recent years, the condition remains a diagnostic challenge. The pain can be due to numerous causes, but once a diagnosis has been made, surgical outcomes appear satisfactory. The purpose of this paper is to describe when surgery is indicated, what is the best procedure and what will be the outcome for the patients.

 

Surgical indications

1. Typical presentation of deep gluteal syndrome
This syndrome typically presents with chronic pain in the gluteal region, often linked to a history of trauma. The trauma may have been direct (impact) or indirect (torn muscle) [5]. The patient describes posterior pain arising from the buttocks and spreading across the back of the thigh suggestive of truncated sciatica of the buttock [6].

Prolonged sitting is uncomfortable or possibly painful and cannot usually be...

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