Endoscopic Sciatic Neurolysis for Deep Gluteal Space Syndrome.

Area of Science:

• Orthopedic Surgery
• Minimally Invasive Procedures
• Neurolysis Techniques

Background:

• Deep gluteal syndrome (DGS) involves sciatic nerve compression by structures deep to the gluteus maximus.
• Conservative management often fails to resolve DGS symptoms, necessitating surgical intervention.

Purpose of the Study:

• To describe and evaluate an endoscopic sciatic neurolysis technique for DGS.
• To assess the efficacy and safety of this minimally invasive approach.

Main Methods:

• A standard endoscopic sciatic neurolysis using an accessory posterolateral portal was performed.
• The technique involves careful sciatic nerve release from fibrous bands using an arthroscopic shaver and radiofrequency device.
• Sciatic nerve mobility was assessed from the piriformis to the lesser trochanter.

Main Results:

• The procedure significantly reduced sitting pain (from 97% to 17%) and narcotic use.
• Patients experienced improved visual analog scale (VAS) pain scores and modified Harris hip scores.
• No major complications were reported in a series of 35 cases.

Conclusions:

• Endoscopic sciatic neurolysis is a safe and effective treatment for DGS, particularly when caused by postoperative scarring.
• Careful patient selection and meticulous surgical technique are crucial for optimal outcomes.
• The procedure demonstrates encouraging results with high patient satisfaction and functional improvement.