Endoscopic Sciatic Neurolysis for Deep Gluteal Syndrome: A Systematic Review

Area of Science:

• Orthopedics
• Neurosurgery
• Minimally Invasive Surgery

Background:

• Deep gluteal syndrome (DGS) is an underdiagnosed condition involving sciatic nerve entrapment in the deep gluteal space.
• Surgical decompression is indicated for DGS cases unresponsive to conservative management.
• There is a growing preference for minimally invasive endoscopic techniques over open surgery.

Purpose of the Study:

• To systematically review the effectiveness of endoscopic sciatic nerve decompression for managing Deep Gluteal Syndrome (DGS).
• To evaluate clinical outcomes and complication rates associated with endoscopic DGS treatment.

Main Methods:

• A comprehensive database search (PubMed, Web of Science, CINAHL, SPORTDiscus) was conducted for English-language clinical studies.
• Included studies focused on DGS treated with endoscopic sciatic nerve decompression.
• Study quality was assessed using the Coleman Methodology Score (CMS).

Main Results:

• Four studies (1 level III, 3 level IV evidence) involving 144 patients were reviewed, with a mean follow-up of 26.3 months.
• Fibrovascular bands, bursal tissue, and musculotendinous structures were common causes of DGS.
• Endoscopic decompression demonstrated a high clinical success rate and low complication rate, though high-quality evidence was lacking. Poorer outcomes were noted in patients with severe sciatic neuropathies.

Conclusions:

• Endoscopic sciatic nerve decompression appears to be an effective and safe treatment for Deep Gluteal Syndrome (DGS).
• Further high-quality research is needed to definitively establish the long-term efficacy and optimal indications for this minimally invasive approach.
• Careful patient selection is important, as outcomes may be less favorable in cases of major traumatic sciatic neuropathies.