title: Surgical anatomy of the sciatic nerve: A meta-analysis.
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.
authors: International Evidence-Based Anatomy Working Group, Krakow, Poland. krtomaszewski@gmail.com.|Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland. krtomaszewski@gmail.com.
authors: Krzysztof A
authors: KA
authors: Tomaszewski
authors: International Evidence-Based Anatomy Working Group, Krakow, Poland.|Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland.
authors: Matthew J
authors: MJ
authors: Graves
authors: International Evidence-Based Anatomy Working Group, Krakow, Poland.|Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland.
authors: Brandon Michael
authors: BM
authors: Henry
authors: International Evidence-Based Anatomy Working Group, Krakow, Poland.|Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland.
authors: Patrick
authors: P
authors: Popieluszko
authors: International Evidence-Based Anatomy Working Group, Krakow, Poland.|Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland.
authors: Joyeeta
authors: J
authors: Roy
authors: International Evidence-Based Anatomy Working Group, Krakow, Poland.|Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland.
authors: Przemysław A
authors: PA
authors: Pękala
authors: International Evidence-Based Anatomy Working Group, Krakow, Poland.|First Faculty of Medicine, Charles University, Prague, Czech Republic.
authors: Wan Chin
authors: WC
authors: Hsieh
authors: International Evidence-Based Anatomy Working Group, Krakow, Poland.|Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland.
authors: Jens
authors: J
authors: Vikse
authors: International Evidence-Based Anatomy Working Group, Krakow, Poland.|Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034 Krakow, Poland.
authors: Jerzy A
authors: JA
authors: Walocha
mesh_terms: D063405:Anatomic Variation; D006801:Humans; D012584:Sciatic Nerve / Q000033:anatomy & histology*
keywords: anatomy; meta-analysis; piriformis muscle; sciatic nerve; variations