The endoscopic treatment of sciatic nerve entrapment/deep gluteal syndrome.
OBJECTIVE
The purpose of this study was to investigate the historical, clinical, and radiographic presentation of deep gluteal syndrome (DGS) patients, describe the endoscopic anatomy associated with DGS, and assess the effectiveness of endoscopic surgical decompression for DGS.


METHODS
Sciatic nerve entrapment was diagnosed in 35 patients (28 women and 7 men). Portals for inspection of the posterior peritrochanteric space (subgluteal space) of the hip were used as well as an auxiliary posterolateral portal. Patients were treated with sciatic nerve decompression by resection of fibrovascular scar bands, piriformis tendon release, obturator internus, or quadratus femoris or by hamstring tendon scarring. Postoperative outcomes were evaluated with the modified Harris Hip Score (MHHS), verbal analog scale (VAS) pain score, and a questionnaire related specifically to sciatic hip pain.


RESULTS
The mean patient age was 47 years (range, 20 to 66 years). The mean duration of symptoms was 3.7 years (range, 1 to 23 years). The mean preoperative VAS score was 6.9 ± 2.0, and the mean preoperative MHHS was 54.4 ± 13.1 (range, 25.3 to 79.2). Of the patients, 21 reported preoperative use of narcotics for pain; 2 continued to take narcotics postoperatively (unrelated to initial complaint). The mean time of follow-up was 12 months (range, 6 to 24 months). The mean postoperative MHHS increased to 78.0 and VAS score decreased to 2.4. Eighty-three percent of patients had no postoperative sciatic sit pain (inability to sit for >30 minutes).


CONCLUSIONS
Endoscopic decompression of the sciatic nerve appears useful in improving function and diminishing hip pain in sciatic nerve entrapment/DGS.
Oklahoma Sports Science & Orthopaedics, Oklahoma City, Oklahoma 73118, USA. haldavidmartin@yahoo.com
Hal D
HD
Martin
Shea A
SA
Shears
J Calvin
JC
Johnson
Aaron M
AM
Smathers
Ian J
IJ
Palmer
D000328:Adult; D000368:Aged; D019299:Decompression, Surgical; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D010147:Pain Measurement; D010808:Physical Examination; D020426:Sciatic Neuropathy / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult